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Unit 5 Lactation
Sample Multiple Choice
_____ 1. Which of the following is NOT a maternal benefit of breastfeeding?
a. Minimizes postpartum blood loss
b. Helps uterus return to nonpregnant size
c. Delays return to fertility
d. MAY help lose weight more quickly e. All of the above would be considered benefits of breastfeeding
_____ 2. Maternal psychological benefits related to breastfeeding include all the following
EXCEPT:
a. increased self-confidence. b. bonding with their infants.
c. slower return to pre-pregnancy weight.
d. all of the above are psychological benefits
e. both a and c
_____ 3. Nutritional benefits of breastfeeding include: a. it provides optimal nutrition to the infant.
b. the balance of nutrients matches requirements needed for human growth.
c. infants do not need additional fluids or water when breastfeeding.
d. the low protein content is easily tolerated.
e. all of the above are considered nutritional benefits
_____ 4. Several mechanisms that may prevent obesity in children have been identified in
children who are breastfed. These include all of the following EXCEPT:
a. children that breastfed exhibited less soft drink consumption as teens.
b. children that breastfed learned self regulation of energy intake.
c. children that breastfed shared characteristics of parents, including healthy lifestyles.
d. children that breastfed had metabolic programming related to chemical
substances in human milk.
e. all of the above are potential protective mechanisms
_____ 5. The cyclic release of what 2 hormones governs pubertal breast development?
a. prolactin & oxytocin
b. progesterone & estrogen
c. prolactin & estrogen
d. progesterone & oxytocin
e. none of the above
_____ 6. The mammary gland contains which of the following functional units to help with
lactogenesis?
a. lobules
b. myoepithelial cells c. alveoli
d. areolas
e. a, b and c
_____ 7. Milk “comes in” during which stage of lactogenesis?
a. lactogenesis I
b. lactogenesis II c. lactogenesis III
d. lactogenesis IV
e. lactogenesis V
_____ 8. What hormone is necessary for the let down reflex?
a. Oxytocin b. Prolactin
c. Estrogen
d. Progesterone
e. both c and d
_____ 9. A petite Southeastern Asian woman was not planning to breastfeed because she felt
her breasts were so small that they would not produce enough milk. What
information would be the best information for her to know?
a. Inadequate food intake by the mother decreases the quantity of milk not the
quality. b. Small breasts would be able to meet infant demands and only store less milk,
thus leading to more feedings.
c. Eating a rice and fruit diet would best support adequate milk production.
d. Drinking more water and milk products would make up for the smaller breast
tissue.
_____ 10. On the second feeding after birth, a first-time mom was concerned that her infant
was not getting enough milk. What would the lactation consultant want the new
mom to know?
a. The first milk is highly concentrated in nutrients and provides a high amount of
protein b. The infant needs only 1½ - 2 tsp at each feeding for the first two days.
c. The infant needs human milk substitutes to ensure adequate energy intake.
d. The infant needs supplemental sugar water to ensure adequate energy intake.
e. a and b
_____ 11. Breast milk is isosmotic which means breast milk _____.
a. contains milk proteins
b. has the same concentration of molecules as the mother’s body plasma
c. has the same concentration of molecules as human milk substitutes
d. has a greater concentration of molecules than human milk substitutes
_____ 12. The major component of breast milk is _____, while the second largest component is
_____.
a. water/lipids
b. lipids/water
c. protein/carbohydrate d. carbohydrate/protein
e. protein/lipids
_____ 13. The dominant carbohydrate in human milk is _____.
a. galactose
b. glucose c. lactose
d. sucrose
_____ 14. The major class of protein found in mature human milk is:
a. whey. b. casein.
c. lactose.
d. maltose.
e. colostrum.
_____ 15. Protein content in human milk is affected by the _____. a. age of the infant
b. amount of protein in the mother’s diet
c. hormone variation in the mother
d. all of the above
e. a and c only
_____ 16. What fat-soluble vitamin is given to all infants at birth?
a. Vitamin A
b. Vitamin D
c. Vitamin E
d. Vitamin K
_____ 17. It is recommended that women allow infants to drain one breast completely before
offering the other breast primarily because:
a. this allows them to get more foremilk which may decrease incidence of diarrhea
& prevent colic. b. this allows them to get both foremilk and hindmilk.
c. this prevents excess gas from forming.
d. b and c only
_____ 18. The 2002 DRI for lactating women is _____ additional calories per day with a 0.8 kg
per month weight loss. a. 200
b. 330
c. 500
d. 650
e. need more information
_____ 19. What nutrient is best absorbed from human milk?
a. Copper
b. Vitamin K
c. Whey proteins
d. Iron
_____ 20. A health care professional was asked by a nursing mom, “How many glasses of
water should I drink a today?” What would be an appropriate recommendation?
a. 6 – 8 glasses
b. 8 – 10 glasses c. > 10 glasses
d. Drink enough fluids to keep your urine pale yellow
_____ 21. Which of the following is NOT a common barrier to breastfeeding initiation?
a. Embarrassment
b. Lack of confidence c. Fear of pain
d. Lack of support
e. All of the above are common barriers to breastfeeding
_____ 22. Shelly is a 25-year-old breastfeeding mom that is trying to lose weight. Her OBGYN has suggested that she go on a very-low-fat diet (~15% of calories) to help with
weight loss. How will this change the fat composition of her breast milk?
a. It will not change the fat composition at all
b. Her breast milk will contain more very-long-chain fatty acids
c. Her breast milk will contain more saturated fatty acids
d. Her breast milk will contain more medium-chain fatty acids e. Her breast milk will contain more cholesterol
Use the following information for questions 23-25:
A young woman comes into your office for a lactation consultation complaining that her 1-month-old baby is colicky and slow to gain weight. Her baby requires 6 to 7 diaper changes
each day and suffers from diarrhea. She tells you she allows the baby to nurse equally on each
breast so that she does not feel “overfull”: she is desperate for help and asks your advice on
what to do. A 24-hour diet history provides the following information about her eating habits.
Breakfast: cereal, milk, banana, and walnut pieces; sometimes she has eggs Lunch: peanut butter sandwich, salad, and grapes with a glass of milk
Dinner: fish or chicken, vegetables, potato or rice, applesauce, and milk
Snacks: change daily, but she likes trail mix because it is easy to eat when nursing
_____ 23. What would the best advice be for this woman? a. Allow your baby to nurse on one breast only until it is completely empty
b. Allow us to evaluate you while you are nursing your baby and see what you are
doing
c. Stop nursing immediately and use an infant formula so your baby starts
growing
d. Use supplemental infant formula after each feeding because the baby is obviously not getting enough to eat
e. a and b only
_____24. What is likely happening to this baby and causing the diarrhea?
a. the baby is not latched on properly b. the mother is not producing enough breast milk
c. the baby is getting too much foremilk and not enough hindmilk
d. the baby has a poor suckle
e. the baby is lactose intolerant
_____ 25. After looking at her diet, what changes could you suggest to help with the baby’s
colic?
a. eliminate all fruit, except canned fruit
b. eliminate nuts
c. eliminate dairy products d. all of the above
e. b and c only
_____ 26. A nursing mother is given a diaper bag full of formula samples and coupons from
her nurse upon discharge from the hospital. What is the nurse telling her?
a. She has been a great patient and her nurse wants to give her a gift b. The nurse wants to make sure she can get a discount on formula should she
decide to try it instead of breastfeed
c. The nurse knows she is returning to work and will need to supplement the
babies diet
d. The nurse is letting her know that formula is just as good as breast milk e. Both b and c
_____ 27. Continuing to nurse while you are sick actually protects your baby because:
a. you do not pass germs through breast milk.
b. your breast milk is full of antibodies that are passed on to your baby.
c. you do not contaminate bottles by handling them. d. infant formulas are higher in vitamins and minerals and help boost the baby’s
immune system.
_____ 28. A baby that is not given vitamin K at birth may have:
a. excessive bleeding due to a lack of blood clotting. b. decreased calcium absorption.
c. increased incidence of colic.
d. increased incidence of diarrhea.
e. all of the above
_____ 29. Contraindications to breastfeeding include all of the following EXCEPT: a. the use of antineoplastic agents.
b. the use of radioactive isotopes.
c. mastitis.
d. drug abuse.
e. all of the above
_____ 30. Research shows that the level of alcohol in breast milk is the same level of alcohol in
maternal plasma levels. The milk/plasma (M/P) ratio would equal _____.
a. <1
b. 0
c. 1 d. >1
_____ 31. A breastfeeding mother asks you if alcohol can be eliminated from her breast milk
by pumping immediately after drinking a few glasses of wine. What would you tell
her? a. Yes; in fact, discarding your breast milk is a good thing to do if you would like to
drink while breastfeeding.
b. Yes; pumping will help, but you need to pump for the next 24 hours and discard
any milk that you collect.
c. No; your breast milk will still contain alcohol; you will need to wait 1 hour per
alcoholic beverage and then pump the milk and discard it to be safe. d. No; the alcohol will still be in the breast milk and will clear from the milk as
soon as it clears from the blood stream: roughly 2 to 3 hours per drink for a
120-pound woman.
e. None of the above will help eliminate alcohol from breast milk.
_____ 32. Which of the following would NOT be a symptom of an infant suffering from an
excess of caffeine?
a. Fussiness
b. Hyperactivity
c. Wakefulness
d. Diarrhea e. All of the above are symptoms
_____ 33. Hyperbilirubinemia in newborns is caused by _____.
a. destruction of red blood cells b. high blood lipid levels
c. high maternal intake of vitamin A
d. labor lasting over 12 hours
_____ 34. Breast milk jaundice is believed to be caused by _____.
a. the infant’s liver’s inability to process bilirubin b. a component in the mother’s milk increasing bilirubin absorption
c. the infant not being fed often enough
d. all of the above
e. a and c only
_____ 35. What nutrition interventions are recommended for management of early jaundice?
a. Frequent short feedings
b. Encourage water feedings
c. Encourage formula feedings
d. Encourage dextrose feedings
_____ 36. What is a possible reason that breastfeeding may prevent allergies?
a. influence on gut microbial flora
b. transfers maternal proteins and immunity
c. transfer of maternal fatty acids and IGA in breast milk
d. low content of allergens e. all of the above
_____ 37. Common pediatric allergens include all of the following EXCEPT:
a. cow’s milk.
b. eggs.
c. peanuts. d. oats.
_____ 38. Which of the following would NOT be considered a nutritional benefit of
breastfeeding a preterm infant?
a. ease of protein digestion b. ease of fat absorption
c. improved lactose digestion
d. better visual acuity
e. all of the above are nutritional benefits
_____ 39. The energy content of breast milk in women who deliver pre-term infants is _____. a. 30 – 37 kcal/oz
b. 40 – 48 kcal/oz
c. 58 – 70 kcal/oz
d. 72 – 120 kcal/oz
_____ 40. What information would be helpful for a first-time mom who would like to know how
to prevent a decrease in milk production?
a. Relax and avoid stress
b. Breastfeed or pump frequently
c. Completely empty your breasts at each feeding, either by nursing or pumping
d. All of the above e. a and c only
_____ 41. A consequence of delayed breastfeeding can lead to jaundice because
a. it produces a state of partial starvation.
b. it can lead to decreased passage of meconium. c. it causes a backup of red blood cells.
d. all of the above
e. a and b only
_____ 42. How could the situation in question #41 be resolved?
a. Make sure mother and baby were nursing correctly and for an adequate length of time
b. Check the mother’s milk supply to make sure she was producing enough milk to
feed her baby
c. Supplement with formula to clear the bilirubin
d. All of the above e. a and b only
_____ 43. Which of the following foods would a pediatrician recommend a nursing mother
restrict with no history of food allergies in the family?
a. Peanuts and tree nuts
b. Wheat c. Soy
d. All of the above
e. None of the above
Unit 6- Infancy Sample Multiple Choice
_____ 1. Infant mortality includes _____.
a. deaths that occur within the first year of life
b. deaths that occur from the day of birth through the first 28 days of life c. deaths that occur at or after 20 weeks of gestation and through the first 28 days
of life
d. deaths that occur in preterm babies
_____ 2. Small for gestational age (SGA) means: a. small for dates.
b. birth weight is <10th percentile for gestational age.
c. appropriate for gestational age.
d. a and b
e. a and c
_____ 3. Newborn health status is assessed by a number of indicators of growth and
development taken right after birth, including:
a. birthweight.
b. length.
c. head circumference. d. all of the above
e. a and b only
_____ 4. The development of motor control starts with:
a. lower leg control, then arm control, and then head control.
b. head and trunk control, then lower legs. c. trunk and arm control, then lower legs, then head and neck.
d. head and leg control that occur simultaneously, then neck control.
e. finger and hand control, then lower legs, then head and neck control.
_____ 5. Which of the following statements best describes motor development in infants? a. Voluntary control of muscles starts from the head and moves down to the legs.
b. Voluntary control of muscles starts from being able to fan toes out at birth to
blinking eyes in response to a loud noise or light.
c. Voluntary muscle control develops with central muscles first and then moves
out to hand muscles.
d. Voluntary muscle control develops with rooting reflex and then moves out to hand muscles.
e. a and c
_____ 6. Infants often have conditions that reflect the immaturity of the gastrointestinal tract which include all of the following EXCEPT:
a. colic.
b. gastroesophageal reflux (GER).
c. unexplained diarrhea.
d. constipation.
e. urinary tract infections.
_____ 7. The AVERAGE caloric need of infants in the first six months of life is _____ per kg of
body weight, based on growth in breast-fed infants.
a. 57 Calories
b. 98 Calories c. 108 Calories
d. 122 Calories
e. 154 Calories
_____ 8. Based on your answer to question #7, a 5-month-old infant would require
approximately _____ total Calories per day based on a weight of 6 kg. a. 648
b. 732
c. 924
d. 1037
e. 1251
_____ 9. Which of the following would NOT be one of the factors accounting for the range of
calories an infant needs?
a. Weight
b. Length
c. Sleep/wake cycle d. Climate
e. Physical activity
_____ 10. Recommended protein intake for infants from the ages of 6 to 12 months is:
a. 0.8 g/kg body weight. b. 1.0 g/kg body weight.
c. 1.2 g/kg body weight.
d. 1.4 g/kg body weight.
e. 1.6 g/kg body weight.
_____ 11. A male infant can get too much protein when a. his motor skills are developed.
b. baby cereal is added to his infant formula.
c. he consumes more formula than recommended for age.
d. his mom is breastfeeding.
e. b and c
_____ 12. The DRI for fluoride in infants < 6 months of age is _____.
a. .01 mcg
b. 0.1 mcg
c. 0.1 mg
d. 1 mg
_____ 13. Which of the following would NOT be a cue an infant might give when signaling that
he/she is hungry and ready to eat?
a. watching the food be opened
b. reaching for the spoon c. showing irritation if the feeding pace is too slow
d. spitting out food on the floor
e. c and d
_____ 14. _____ is an unsafe food to give to one-year-old infants.
a. Cooked green beans b. Raisins
c. Cooked oatmeal
d. Cooked ground hamburger
_____ 15. Recommendations for introducing a baby to food on a spoon include all of the following EXCEPT:
a. time the first spoon-feeding experiences for when the baby is not overly tired.
b. offer a large variety of foods for them to choose from.
c. give the baby time to open his or her mouth and extend the tongue towards
food.
d. place the bowl of the spoon on the tongue with slight downward pressure. e. keep the spoon level and do not scrape food into the baby’s mouth.
_____ 16. The recommended age for weaning an infant from the breast or bottle to a cup is
from _____ months.
a. 6 to 8 b. 8 to 10
c. 10 to 12
d. 12 to 24
e. 24 to 36
_____ 17. The FIRST step in correcting failure to thrive (FTT) is: a. feeding the baby on a regular schedule.
b. providing a stimulating environment when the baby is eating.
c. increasing calorie and protein intake.
d. enrolling the child in an early intervention program.
e. obtaining social support for the family.
_____ 18. A possible cause of nonorganic failure to thrive in infants is:
a. too much water is added when mixing the infant formula.
b. an ear infection.
c. breastfeeding as the sole source of nutrition.
d. fetal undergrowth during pregnancy.
_____ 19. Good feeding practices to limit baby bottle caries and/or ear infections related to
baby bottles include all of the following EXCEPT:
a. letting the baby have juice in a bottle throughout the day to have as desired. b. offering juice in a cup.
c. limiting the use of a bottle as part of a bedtime ritual.
d. examining and cleaning emerging baby teeth on a regular basis.
e. offering only water in a bottle to sleep with.
_____ 20. Lactose intolerance is: a. a milk protein allergy.
b. characterized by cramps, nausea, and pain.
c. caused by an inability to digest lactose.
d. all of the above
e. b and c only
_____ 21. Recommendations to relieve colic include:
a. swaddling the baby.
b. changing baby formulas if the infant is not breastfeeding.
c. evaluate and improve positioning of the baby for eating.
d. ensuring that the baby is burped often. e. all of the above
_____ 22. Which of the following are warning signs indicating growth problems?
a. Lack of head circumference gain in one month
b. Weight loss with a regain in two weeks c. Plateau in weight gain
d. a and b
e. a and c
_____ 23. A newborn girl weighs 8 pounds at birth. Plot her weight on the provided growth
chart and indicate which of the following % tiles she falls in. a. 10th
b. 25th
c. 50th
d. 75th
e. 90th
_____ 24. A premature infant has been on a respirator since birth. He is now 6 months old
and ready to start solids, although he does not like it when a spoon is placed in his
mouth. What might be the cause of this?
a. He dislikes the spoon because he is associating it with discomfort
b. Premature infants should not start solids until they are at least 8 months, so he is not old enough
c. A critical period for mouth exploration has been missed due to the respirator
d. All of the above
e. a and c only
_____ 25. How much would you expect a baby to weigh at 6 months of age assuming normal
growth, if she weighed 6 pounds, 9 ounces at birth?
a. 12 pounds 4 ounces b. ~13 pounds 5 ounces
c. ~15 pounds 3 ounces
d. ~16 pounds 8 ounces
e. need more information
_____ 26. To lessen the risk of food allergies in infants, you can: a. breastfeed your infant.
b. use a hypoallergenic infant formula.
c. offer cow’s milk before they turn 1.
d. all of the above
e. a and b only
_____ 27. An infant with a suspected protein intolerance should be:
a. put on a soy formula, because plant proteins are well tolerated.
b. put on a hydrolyzed formula because the protein is broken down.
c. breast fed only because breast milk is the gold standard to feed babies with.
d. put on IV fluids with a fat replacement. e. both c and d
_____ 28. A child with diarrhea and an allergy to lactose would most likely be given:
a. a cow’s milk-based formula (Enfamil).
b. a soy formula (Prosobee). c. a protein hydrolysate formula (Nutramigen).
d. an amino acid-based formula (Neocate).
e. none of the above
_____ 29. In-depth nutrition assessments make sure nutrition is not limiting an infant’s
growth and development and are typically needed by three main groups of infants which include all of the following EXCEPT:
a. infants born between 37 and 42 weeks.
b. infants born before 34 weeks of gestation.
c. infants born with consequences of abnormal development during pregnancy
such as a heart malformation. d. infants at risk for chronic health problems
e. All of the above situations would require an in-depth nutrition assessment.
_____ 30. Primary components included in nutrition evaluations of children with special
health care needs include _____.
a. growth, nutrient content of diet, and how the child is fed b. growth, nutrient content of diet, and cost
c. growth, course of mother’s pregnancy, and substance abuse in the home
d. health care insurance eligibility, growth, and nutrient content of diet
_____ 31. In which of the following cases would EXTRA calories be needed for a child? a. Infections
b. Fever
c. Difficulty breathing
d. Recovery from surgery
e. All of the above
_____ 32. In preterm births, which organ is stressed, reducing an infant’s ability to digest
protein?
a. Heart b. Small intestine
c. Liver
d. Gallbladder
_____ 33. Infants need a high-fat diet compared to older people; therefore, up to _____ of
calories from fat may be recommended. a. 25%
b. 32%
c. 40%
d. 55%
e. 60%
_____ 34. The recommendations for VLBW or ELBW infants who are breastfeeding but have
limited pancreatic enzyme production is to supplement _____.
a. long-chain fatty acids
b. medium-chain fatty acids
c. short-chain fatty acids d. a and b
e. b and c
_____ 35. Refinements in the usual method of measurement and interpretation of growth are
needed in conditions known to influence growth and development. These include: a. using specialized growth charts for specific diagnoses.
b. using indicators of body composition, such as body fat measures.
c. special attention to indicators of brain growth, such as measuring head
circumference.
d. all of the above
e. a and c only
_____ 36. What is the most reliable process for evaluating weight changes in a breastfeeding
preterm infant?
a. Plot weights on growth charts from the federal government.
b. Record measured infant weights in chart and evaluate changes over time. c. Obtain and use only the hospital’s recorded birth weight.
d. Monitor maternal weight loss over time.
_____ 37. What is one of the signs associated with inadequate growth?
a. Weight loss within the first week after birth
b. Weight remaining stable over 3 months c. Weight gain over 3 months
d. Missing weights in the medical record
_____ 38. Growth charts are unreliable for which type of infants?
a. Infants born pre-term with weights <2500 g b. Infants born to women who followed a vegetarian diet during pregnancy
c. Full-term infants with LBW
d. a and c
_____ 39. What is the gestation-adjusted age for a 9-month-old infant born preterm (32
weeks)?
a. 6.5 months b. 7 months
c. 8 months
d. Unable to determine
_____ 40. The initial nutrition problems resulting from VLBW and ELBW are:
a. these newborns cannot nurse like a full-term infant. b. most require respiratory support to breathe.
c. these newborns are more likely to have food allergies and difficulty feeding.
d. a and b
e. b and c
_____ 41. There are several reasons why a baby that is born preterm may be hard to feed.
These include:
a. fatigue.
b. high tolerance of volume.
c. low tolerance of volume. d. a and b
e. a and c
_____ 42. Interventions are required to assure adequate growth and development when
feeding problems are identified in infancy. Which of the following would NOT be one of these interventions?
a. Assessing growth less frequently
b. Monitoring the infant’s intake of all liquids and foods to ensure enough is being
consumed
c. Changing the frequency and volume of feedings as needed
d. Changing the diet composition to improve nutrient density e. Providing parent education or support
_____ 43. Differences in preterm and term infant feeding include:
a. preterm infants may have oral hypersensitivity.
b. term infants accept food readily by mouth. c. term infants have more stable feeding position from newborn reflexes.
d. all of the above
e. a and c only
_____ 44. Catch-up growth and weight gain are typically emphasized with very-low-birth
weight (VLBW) babies; this can sometimes result in: a. overfeeding.
b. gastrointestinal discomfort.
c. specially prepared meals.
d. behavior problems.
e. a and b
Unit 7- Toddler/Preschooler
Sample Multiple Choice
_____ 1. Characteristics of preschool age children include:
a. increasing language skills.
b. ability to control behavior.
c. increasing autonomy.
d. all of the above
e. a and c only
_____ 2. When an infant reaches toddler age (1 year), her weight is _____ from her
birthweight.
a. doubled
b. tripled c. increased by 5%
d. varied but has a minimum of 30 lbs gain
_____ 3. Toddlers gain 8 oz/month and preschoolers gain _____ lb/year.
a. 4.4
b. 6 c. 8
d. 10
_____ 4. Measurements that track a child’s growth over time include:
a. BMI. b. weight.
c. head circumference.
d. height.
e. all of the above
_____ 5. There is overlap between the two sets of growth charts health care professionals use for children between the ages of 24 and 36 months of age. If a child’s recumbent
length is measured, than a _____ is the appropriate chart to use. If the child is over
2 years old and measured standing, the _____ is the correct choice.
a. 2 to 10 year old growth chart/birth to 36 month growth chart
b. birth to 36 month growth chart/2 to 20 year old growth chart c. You would use a body mass index (BMI) chart for both.
d. Neither; you only track weight, height, and head circumference.
e. None of the above are correct.
_____ 6. Which of the following would be considered a cue of readiness for weaning?
a. disinterest in breast or bottle feeding b. the ability to use fine motor skills
c. the ability to use utensils
d. all of the above
e. none of the above
_____ 7. At what age range can babies begin to wean from the bottle to the cup?
a. 6 – 9 months
b. 9 – 10 months
c. 12 – 14 months
d. > 14 months
_____ 8. Foods that should not be served to children less than two years of age
because of their potential as choking hazards include:
a. whole grapes. b. hot dogs.
c. peanuts or popcorn.
d. cotton candy.
e. a, b, and c only
_____ 9. One “rule of thumb” regarding portion sizes for toddlers is?
a. Serve them as you would serve yourself and let them decide how much they
would like to eat.
b. 1 tablespoon of food per year of age.
c. Allow toddlers to self serve and graze throughout the day as there are no actual portion sizes for this age group.
d. ¼ cup of protein-type foods and ½ cup of all others.
e. None of the above are correct.
_____ 10. Temper tantrums generally peak between _____.
a. 1 and 3 years of age b. 2 and 4 years of age
c. 3 and 5 years of age
d. 4 and 6 years of age
e. 5 and 7 years of age
_____ 11. Preschool age is a good time to teach children about foods, food selection, and
preparation because:
a. they are able to help prepare meals.
b. they want to be helpful and please parents and caregivers.
c. it helps them learn about colors and shapes.
d. it helps them prepare for kindergarten. e. all of the above
_____ 12. Investigators have defined three temperamental clusters of children’s behavior. They
include:
a. the “easy,” “picky,” and “fussy” child. b. the “picky,” “messy,” and “fussy” child.
c. the “easy,” “difficult,” and “slow-to-warm-up” child.
d. the “picky,” “difficult,” and “slow-to-warm-up” child.
e. none of the above
_____ 13. Approximately what proportion of children have an “easy” temperament? a. 10%
b. 15%
c. 30%
d. 40%
_____ 14. All of the following are food preferences of toddlers EXCEPT _____.
a. sweet
b. salty
c. sour
d. energy-dense foods
_____ 15. Studies have shown that restricting a young child’s access to palatable food may:
a. promote desirability of that particular food. b. increase disinterest in new foods.
c. encourage them to overeat these foods and have negative feelings.
d. all of the above
e. a and c only
_____ 16. At a daycare center, a small chocolate candy bar was given to only the three year olds who ate everything at mealtime. Choose the best description of the feeding
relationship problem between the daycare center staff and three year olds.
a. The daycare center staff has served inappropriate portion sizes for toddlers.
b. The daycare center staff has severely restricted “junk foods.”
c. The daycare center staff has inappropriately used coercion to control food intake.
d. The daycare center staff has taught the children to like sweets.
_____ 17. Approximately how many exposures to a new food might it take for a toddler to
accept the flavor or taste?
a. 1 – 2 b. 5 – 7
c. 8 – 10
d. >11
_____ 18. Meal preparation activities appropriate for a two year old would include all of the following EXCEPT:
a. wiping tabletops.
b. scrubbing vegetables.
c. using an eggbeater.
d. breaking cauliflower.
e. tearing lettuce leaves.
_____ 19. The DRI equations for estimating a child’s energy requirements are based on a
child’s:
a. age, height, and weight.
b. age, height, weight, and BMI. c. age, weight, height, BMI, and activity level.
d. activity level and gender.
e. a and d
_____ 20. Common nutrition problems among young children include all of the following
EXCEPT: a. iron-deficiency anemia.
b. dental caries.
c. constipation.
d. lead poisoning.
e. all of the above are common nutrition problems in young children
_____ 21. The major contributors to the increase in childhood weight problems are thought to
be:
a. high-energy, high-fat diets.
b. sedentary lifestyles.
c. lack of time to eat regular meals. d. poor-quality food in the school cafeteria.
e. a and b
_____ 22. Estimate the energy needs of a four-year-old, female toddler weighing 35 lb (16 kg)
who is physically active. a. ~1200 kcalories
b. ~1400 kcalories
c. ~1600 kcalories
d. >1800 kcalories
_____ 23. The acceptable macronutrient distribution ranges (AMDRs) for fat are _____ for children 1 to 3 years and _____ for children 4 to 18 years old.
a. 20-30%/<30%
b. 20-30%/25-35%
c. 30-0%/<30%
d. 30-40%/25-35% e. It is the same for both age groups at <30%.
_____ 24. The RDA for iron for children ages 4-8 years is _____.
a. <5 mg/day
b. 8 mg/day
c. 10 mg/day d. 18 mg/day
e. There is no RDA for iron in this age group.
_____ 25. The general fiber recommendation for 5-year-old children is _____/day.
a. 5 g b. 7 g
c. 10 g
d. 25 g
e. There are no recommendations for fiber.
_____ 26. Which of the following children would NOT be at risk for a nutrient deficiency? a. children suffering from abuse or neglect
b. children who consume a vegetarian diet without dairy products
c. children who consume only a few types of food
d. children with poor eating habits
e. none of the above (i.e., all of the above are at risk)
_____ 27. Recommendations for toddlers whose parents are vegetarian include all of the
following EXCEPT _____.
a. encourage toddlers to eat bran muffins when serving fruits and vegetables
b. serve cheese or avocados in toddlers’ diets
c. encourage toddlers to eat two to three snacks d. include good sources of vitamin B12 in toddler’s diets or supplement, if required
_____ 28. Which of the following is not appropriate for toddlers/preschoolers?
a. 1 cup per day of fruit juice
b. 2 cups per day of milk c. >9 oz per day of soft drinks
d. water as a “thirst quencher”
_____ 29. Parents can influence the eating behaviors of toddlers in which of the following
ways?
a. What they bring into the house and have available to eat b. How they prepare food and when they serve it
c. Their attitudes and behaviors around food
d. All of the above
e. a and b only
_____ 30. In general children tend to consume more than enough _____ in their diets and meet the levels of most nutrients except _____.
a. protein & fat/vitamin E & zinc
b. fat & carbohydrate/vitamin D & calcium
c. protein & carbohydrate/vitamin C & iron
d. protein & carbohydrate/vitamin A & fluoride e. carbohydrate & fiber/iron & vitamin D
_____ 31. According to Ellyn Satter, which of the following would be considered a common
mistake that a parent might make when feeding a toddler?
a. Don’t allow a child to determine how much or whether they want to eat
b. Allow the child to determine what food to eat and where the food is eaten c. Allow the child to determine when the food is eaten
d. All of the above are common mistakes that parents make when feeding toddlers
e. b and c only
_____ 32. After observing several family meals, you notice that the parents continually praise
their children for cleaning their plates. They are:
a. unconsciously rewarding the children for eating.
b. altering the children’s ability to self regulate food intake.
c. encouraging their children to be good eaters by offering praise.
d. all of the above e. a and b
_____ 33. One of the most positive influences a parent can have on their child’s eating habits
would be:
a. acting as a role model. b. putting them in daycare so they can learn eating habits from others.
c. controlling their food intake.
d. serving children the same size portions they eat.
e. all of the above
_____ 34. Signs that indicate feeding problems in toddlers include: a. low interest in eating.
b. long mealtimes (>30 minutes).
c. preferring solids over liquids.
d. all of the above
e. a and b only
_____ 37. Failure to thrive (FTT) may occur from a complex interplay of medical and
environmental factors which include all of the following EXCEPT:
a. pediatric AIDS.
b. digestive problems such as gastrointestinal reflux.
c. post-term birth and high birth weight. d. asthma.
e. neurological conditions such as seizures.
_____ 38. Generally, a diagnosis of FTT is suspected in children with chronic illnesses when
their growth declines _____ percentiles and they are near or below the lowest percentiles.
a. 2
b. 3
c. 4
d. 5
_____ 39. True food allergies are estimated to occur in _____ of children.
a. <1%
b. 2 – 8%
c. 10 – 15%
d. >20%
_____ 40. Typical food allergies do NOT include _____.
a. eggs
b. soy
c. corn
d. peanuts
_____ 41. Treatment for an anaphylactic reaction to a food is:
a. mouth-to-mouth resuscitation.
b. injection with epinephrine. c. application of an oxygen mask.
d. intravenous fluids.
e. All of the above would work in this type of situation.
Use the following diet record to answer questions 42-44.
Breakfast:
Instant oatmeal sweetened with brown sugar
Mashed banana
8 oz fortified juice
Lunch: Macaroni with butter
8 oz. fortified juice
Snack:
Goldfish crackers
12 oz fortified juice
Dinner:
Noodles with butter 12 oz fortified juice
_____ 42. What would indicate that the 2-year-old girl following this diet has a potential
feeding problem?
a. Lack of variety b. Bland food choices
c. Excessive fluid intake
d. All of the above
e. a and c only
_____ 43. What foods could you suggest to increase variety and still make it easy for her to
eat?
a. Pureed pears or peaches
b. Macaroni made with milk and cheese
c. Peanut butter sandwich crackers
d. Fortified juice smoothie e. All of the above
_____ 44. If a child tires out easily while eating a piece of fruit and will not eat anything else,
what can be done to increase her intake?
a. Change to pureed fruit or a fruit sauce b. Softly cook vegetables
c. Add protein to soups or noodles
d. Try a nutritional supplement like Boost
e. All of the above
.
Unit 8-Schoolage
Sample Multiple Choice
_____ 1. Preadolescence is generally defined as ages _____ for girls and ages _____ for boys.
a. 5 to 10/7 to 9
b. 7 to 9/9 to 11
c. 9 to 11/10 to 12
d. 10 to 12/11 to 13
e. 11 to 13/12 to 14
_____ 2. Adequate nutrition, especially eating breakfast, has been associated with:
a. improved academic performance.
b. reduced tardiness and absences from school.
c. an increase in childhood obesity. d. all of the above
e. a and b only
_____ 3. A child with a body mass index (BMI) equal to or greater than the 85th percentile,
but less than the 95th percentile, means:
a. the child is a normal weight. b. the child is at risk of becoming overweight.
c. the child is overweight.
d. the child is obese.
_____ 5. Studies show that children of parents who impose authoritarian methods of control
on their eating were:
a. likely to have healthy eating habits.
b. less likely to be responsive to energy density.
c. developing fewer eating-related issues.
d. more able to be self sufficient in the kitchen. e. a and d only
_____ 6. Equations for estimating energy requirements are based on:
a. gender, age, height, weight, and physical activity.
b. gender, body mass index, and physical activity. c. age, height, weight, body mass index, and activity level.
d. age, weight, body mass index, activity level, and food intake.
e. standards developed based on age and gender only.
_____ 7. What is the recommended adequate intake of total fiber for children between the
ages of 4 and 8? a. 25 g/day
b. 29 g/day
c. 31 g/day
d. 35 g/day
_____ 8. The BMI for a boy who is 9 years old, weighs 90 lb (40.9 kg), and is 53 in (134 cm)
tall is: a. 22.7.
b. 24.3.
c. 26.8.
d. 28.2.
_____ 9. Plot the BMI you calculated from the previous question on the CDC growth chart above. What is the classification for this child’s weight status?
a. Under weight
b. Normal weight
c. Overweight
d. Obese
_____ 10. What would be the next recommended course of action for this young boy?
a. Nothing, he is too young to worry about; just check his BMI yearly
b. He should have an in-depth medical assessment to check for secondary
complications
c. Weight maintenance or gradual weight loss of no more than 1 pound per week d. Weight loss of at least 2 pounds per week
Body mass index-for-age percentiles:
Boys, 2 to 9 years
_____ 11. If weight loss was needed, what would you recommend for him?
a. A strict Calorie-controlled diet
b. Absolutely no sweets or snack foods c. Attainment of an ideal body weight
d. Changing unhealthy lifestyle behaviors and promoting healthy ones
e. A high-protein diet is most successful with children
_____ 12. Based on the DRIs, the recommended protein intake for boys and girls between the
ages of 4 to 13 is _____ body weight/day. a. 0.55 g/kg
b. 0.7 g/kg
c. 0.8 g/kg
d. 0.95 g/kg
e. 1 g/kg
_____ 13. The protein requirement for a 12-year-old girl weighing 105 pounds (48 kg) based on
the DRIs would be:
a. 29 g.
b. 38.4 g.
c. 45.6 g. d. 48 g.
e. 57.6 g.
_____ 14. Which of the following foods would be MOST likely to promote dental caries?
a. Raisins b. Gummy bears
c. Cheddar cheese
d. Peanut butter
e. a and b only
_____ 15. Health consequences of obesity occur with increased frequency in obese children, and include all of the following EXCEPT:
a. higher concentrations of liver enzymes.
b. osteoporosis.
c. hypertension.
d. hyperlipidemia. e. All of the above are health consequences of obesity.
_____ 16. “Adiposity rebound” can be defined as:
a. the period in which your weight “rebounds” and settles in at your normal weight.
b. the normal increase in BMI which occurs after BMI declines and reaches its
lowest point. c. the point at which you have the greatest amount of fat you will ever have,
typically between the ages of 8 and 10.
d. the weight you attain by the age of 13 after you have had a growth spurt.
e. none of the above.
_____ 17. The most significant predictor of childhood obesity has been found to be:
a. low family income.
b. food insecurity.
c. maternal obesity.
d. lower cognitive stimulation.
e. a and d only
_____ 18. A dose-response relationship has been detected in the prevalence of obesity and
time spent viewing television. For each additional hour of television viewed in the
12- to 17-year-old group, the prevalence of obesity increased by: a. 2%.
b. 5%.
c. 9%.
d. 15%.
e. 21%.
_____ 19. What are the proposed mechanisms by which television viewing contributes to
obesity?
a. Reduced energy expenditure
b. More commercials advertising inappropriate foods c. Increased intake while watching television
d. All of the above
e. a and c only
_____ 22. According to the DRIs, the Acceptable Macronutrient Distribution Range (AMDR) for
fat is _____ of energy for children 4 to 18 years of age. a. <30%
b. 25 – 35%
c. 30 – 40%
d. ≤ 40%
e. There are no recommendations for fat for this particular age group.
_____ 23. Which of the following foods would be the best choice for a parent trying to increase
fiber in their child’s diet?
a. Protein or energy bar
b. Fresh fruits, vegetables, and legumes
c. Fresh juice and bread d. Canned fruits
e. All of the above would be great sources of fiber.
_____ 24. What are the three most frequent places school-aged children consume snacks
when eating away from home? a. Car, home, and fast-food restaurants
b. Home, fast-food restaurants and friend’s houses
c. School cafeteria, someone else’s house, and fast food restaurants
d. School classroom, car, and fast-food restaurants
_____ 25. Parents are encouraged to do all of the following in order to increase physical activity in their children, EXCEPT:
a. set a good example by being physically active themselves.
b. encourage children to be physically active at home.
c. plan every vacation around an activity when traveling.
d. limit television watching and video games. e. join children in physical activities.
Using the following information, answer questions 26-29.
Jane is an 8-year-old girl that weighs 56.5 pounds (25.6 kg), is 51 inches tall, and is an active
girl that enjoys lots of outdoor activities. Her total caloric intake is 1800 Calories per day consisting of 80 grams of fat, 225 grams of carbohydrate, and 45 grams of protein. She likes
vegetables and eats lots of fruit; the only food she truly dislikes is milk.
_____ 26. Jane gets _____% of her energy from fat.
a. 20 b. 25
c. 30
d. 35
e. 40
_____ 27. Is this within the acceptable macronutrient distribution range (AMDR) for fat for a child her age?
a. Yes
b. No
c. Cannot be determined from the information provided
_____ 28. What percentage of her total caloric intake does protein contribute?
a. 10%
b. 15%
c. 18%
d. 20%
e. 25%
_____ 29. Is she eating more, less, or the recommended amount of protein compared to the
DRI for a girl her age?
a. More
b. Less c. Exactly as much as the DRI recommends
_____ 30. What nutrient(s) would be of most concern considering her dislike of milk?
a. Protein
b. Calcium
c. Vitamin D d. All of the above
e. b and c
_____ 31. Which of the following is NOT considered a possible predictor of childhood overweight?
a. Decreased physical activity
b. High amount of energy coming from fats and sweets
c. Low family income
d. Lower cognitive stimulation
e. All of the above are considered to be possible influences
Unit 9- Adolescent
Sample Multiple Choice
_____ 1. The difference between assessing nutrient needs in adolescents and adults is _____.
a. adolescents have significantly more body composition changes during puberty
than adults
b. adolescents exercise more than adults
c. adolescents drink less alcohol than adults d. adolescents have more psychological problems than adults
_____ 2. Which of the following would NOT be a biological change occurring during puberty?
a. sexual maturation
b. accumulation of skeletal mass
c. increases in height and weight
d. accumulation of baby fat e. changes of body composition
_____ 3. Early adolescence is defined as the years between:
a. 9 and 11.
b. 11 and 14.
c. 13 and 16. d. 15 and 17.
e. 18 and 21.
_____ 4. Females that mature early have been found to have/do all of the following EXCEPT:
a. less eating problems and a better body image. b. smoke.
c. drink alcohol.
d. engage in sexual behavior.
e. All of the above are true among females that mature early.
_____ 5. Snacks account for _____ of daily energy intakes among adolescents. a. 15%
b. 25%
c. 39%
d. 43%
e. 55%
_____ 6. Food choices made by adolescents tend to be high in _____ and relatively low in
_____.
a. sugar, sodium, and fat/vitamins and minerals
b. calories/vitamins and minerals
c. vitamins and minerals/sugar, sodium, and fat d. overall calories/fat, sugar, and sodium
e. none of the above are correct
_____ 7. Fast-food restaurants and food courts are favorite eating places for adolescents for
several reasons. Which of the following would NOT be one of these reasons? a. They offer a social setting.
b. The food is relatively expensive.
c. Fast food can be eaten outside of the restaurant.
d. They provide fast service.
e. All of the above ARE reasons that fast-food restaurants are popular.
_____ 8. Health advantages for an adolescent consuming a vegetarian diet include:
a. high intake of complex carbohydrates.
b. high levels of B vitamins, especially B12.
c. high levels of vitamins and minerals found in plant foods.
d. all of the above e. a and c only
_____ 9. The vegetable most frequently consumed by adolescents is:
a. carrots.
b. lettuce.
c. potatoes. d. tomatoes.
e. a and c only
_____ 10. Using the Sexual Maturation Rating (SMR), the PEAK velocity of linear growth for
males occurs at _____ years of age, on average. a. 12
b. 14.4
c. 16.5
d. 18.3
_____ 11. Females experience a _____ increase in body fat during puberty. a. 40%
b. 50%
c. 100%
d. 120%
_____ 12. A 14-year-old female weighed 150 lb at the end of SMR Stage 3 and had an
estimated 25% body fat stores. Which of the following statements best describes her
reproductive capabilities?
a. She has adequate body fat stores; unable to start menses due to SMR rating.
b. She has adequate body fat stores; has started and can support menses.
c. She has limited body fat stores; unable to support menses due to body composition stores.
d. a and b
e. a and c
_____ 13. During peak weight gain, adolescent males gain approximately _____ lb/year. a. 10
b. 20
c. 30
d. 40
_____ 14. By the age of 18, more than _____ of adult skeletal mass has been formed. a. 50%
b. 75%
c. 85%
d. 90%
e. 99%
_____ 15. The protein requirement is greatest for females when the height growth spurt
occurs. What age range would this be?
a. 11 – 14 years
b. 15 – 18 years
c. 19 – 24 years d. > 24 years
_____ 16. The best reason for wanting young adolescents to consume foods that provide
adequate calcium is _____.
a. young adolescents expend more energy from increased physical activity and need more calcium
b. young adolescents do not have much money and dairy foods are the least
expensive to buy
c. young adolescents retain four times as much calcium than adults and build
bone mass
d. young adolescents fight with their parents a lot and this would eliminate one food battle
_____ 17. A reasonable number of goals to work toward with adolescents during a
counseling session would be:
a. one or two. b. two or three.
c. three or four.
d. no more than five.
e. It is not appropriate to set ANY goals with an adolescent.
_____ 18. A female adolescent will be running the one-mile race in a track meet at approximately 5:20 p.m. Which of the foods below is the best after-school snack?
a. Bran muffin from McDonald’s
b. 12-oz can Mountain Dew from the school vending machine
c. Half of cheese sandwich and 100% fruit juice box brought from home
d. Snickers candy bar from nearby convenience store
_____ 19. School-based programs can play important roles in promoting healthy eating and
physical activity. Efforts to promote physical activity and healthy eating should
include the following in a school health program:
a. school food service.
b. health services. c. school physical education programs.
d. curriculum.
e. all of the above
_____ 21. Which of the following food sources would be highest in heme iron? a. Spinach
b. Beef
c. Molasses
d. Dried prunes
e. All of the above are high in heme iron
_____ 22. Consumption of which of the following foods would help ensure an adolescent was
getting adequate folate in her or his diet?
a. Fortified orange juice
b. Asparagus
c. Enriched grains d. Total cereal
e. All of the above
_____ 25. What would the estimated protein need be for a 65-kg adolescent male who is 15
years old?
a. 55 g b. 65 g
c. 75 g
d. 90 g
e. 130 g
Use the Topango’s menu provided below to answer questions 27-29.
_____ 27. An adolescent is considering Topango’s menu and would like to choose the food with
the lowest percentage of fat calories. This would be the:
a. breakfast burrito w/ bacon.
b. breakfast quesadilla w/ bacon. c. primo taco salad.
d. beef taco.
e. primo nachos.
_____ 28. Would this food fit within the current recommendations for fat consumption? a. No, it is high at 37% fat
b. No, it is high at 47% fat
c. No, it is low at 17% fat
d. Yes, it is only 30% fat
e. Need more information
_____ 29. What beverage would be a good accompaniment to this meal and provide a nutrient
that is usually low in adolescent diets?
a. 1 or 2% milk
b. Diet soda
c. Water d. Regular soda
e. Iced tea with sweetener
_____ 30. Athletes should consume 6 – 8 oz fluid prior to exercise, _____ oz fluid every 15-20
minutes during physical activity, and at least _____ oz fluid following exercise. a. 0; >32
b. 4 – 6; 8
c. 4 – 6; 12
d. 8 – 10; 8
_____ 31. Each pound of body weight lost during an activity requires ingestion of _____ ounces
of fluid following the activity to maintain proper hydration.
a. 8
b. 16
c. 24 d. 32
e. 48
_____ 32. A juice or sports drink that contains no more than _____ carbohydrate may allow for
better hydration and physical performance than those that are more concentrated.
a. 2% b. 4%
c. 6%
d. 8%
e. 10%
_____ 33. Carbohydrate loading is the process of:
a. eating as much carbohydrate as possible on a daily basis to “load” your muscle
stores.
b. eating low-carbohydrate foods for the first 3 days of the week, while continuing
to exercise, and then consuming a high-carbohydrate diet the 3 days prior to
competition while exercising minimally. c. eating a ratio of 40% carbohydrate, 30% fat, and 30% protein in order to shift to
a “fat burning” metabolism.
d. all of the above
e. a and c only
_____ 34. A teenage girl ate Christmas dinner at her step-mother’s house and following a
creamy dessert, announced, “I am fatter than all of my classmates; I am going to
stop eating for 5 days!” Important behaviors the step-mother should model include
all of the following EXCEPT:
a. eating well-balanced meals as part of her normal routine.
b. showing the step-daughter love without using food. c. identifying strengths of the step-daughter that are not eating related. d. beginning a subscription to Weight Watcher’s magazine for the stepdaughter.
_____ 35. Key features of anorexia nervosa include all of the following EXCEPT:
a. refusal to maintain body weight over a maximum normal weight for age.
b. intense fear of gaining weight. c. amenorrhea.
d. a distorted body image.
e. All of the above are key features of anorexia.
_____ 36. Key features of bulimia nervosa include:
a. recurrent episodes of rapid consumption of a large amount of food in a discrete
period of time. b. use of laxatives or diuretics.
c. feeling of control over eating.
d. all of the above
e. a and b only
_____ 37. Binge-eating disorder is a condition in which the person feels a subjective sense of a loss of control over binge eating, which is indicated by the presence of three of five
criteria. Which of the following would NOT be one of these criteria?
a. eating rapidly
b. eating only until full
c. eating when not physically hungry d. eating when alone
e. feelings of self disgust
_____ 38. A main contributing factor to dieting behaviors and disordered eating is:
a. peer pressure.
b. parent pressure for children to be “perfect.” c. body dissatisfaction.
d. high self esteem.
e. genetics.
_____ 39. Key goals of nutritional care for someone in treatment for an eating disorder would
include:
a. establishing a regular pattern of nutritionally balanced meals.
b. gradually introducing forbidden foods into the diet.
c. avoiding dieting behaviors and excessive exercise.
d. thoroughly assessing dietary intake and adequacy. e. all of the above are key goals
Unit 10- Older Adults
Sample Multiple Choice
_____ 1. Which of the following has NOT contributed to life expectancy rate estimates?
a. Infant mortality rates
b. Infectious and chronic disease
c. Safe food handling
d. Gunshot wound or car accident
e. Childhood mortality
_____ 2. The human life span is projected to be from _____ years.
a. 102 – 104
b. 105 – 110
c. 110 – 120 d. >120
_____ 3. Aging theories try to explain the mechanisms behind:
a. loss of physical resilience.
b. decreased resistance to disease.
c. physical and mental changes associated with aging. d. gray hair and wrinkles.
e. a, b, and c only
_____ 4. Theories of aging fall into three major categories. Which of the following would NOT
be considered one of these? a. Natural selection
b. “Wear and tear”
c. Programmed aging
d. Caloric restriction
e. a and b
_____ 4. Programmed aging theorizes that senescence occurs because
a. the telomeres capping the ends of chromosomes become shorter with each cell
division and their loss eventually stops the chromosomes from replicating,
resulting in senescence.
b. mistakes in the replication of cells or buildup of damaging by-products from biologic processes eventually destroy the organism.
c. unstable oxygen, formed normally during metabolism, can damage cells by
initiating reactions that break down cells membranes.
d. fast-paced living shortens lifespan.
e. b and c only
_____ 5. Of all the physiologic changes that occur with aging, the biggest effect on nutritional
status is due to shifts in the _____.
a. endocrine system
b. musculo-skeletal system c. gastrointestinal system
d. nervous system
e. renal system
_____ 6. Oral health depends on several organ systems working together. Which of the
following is NOT one of these organ systems? a. Saliva from gastrointestinal secretions
b. Tooth and jaw movement
c. The mucus membranes
d. Taste buds
e. All of the above contribute to good oral health functioning.
_____ 7. A decrease in physical activity and in basal metabolic rate from early to late
adulthood results in _____% fewer calories needed for weight maintenance.
a. 7-10
b. 12 c. 20
d. 25
e. 34
_____ 8. It is difficult to meet vitamin and mineral needs at Calorie levels below a. 1300.
b. 1600.
c. 1800.
d. 2000.
e. It is hard to meet vitamin and mineral needs at ANY calorie level; therefore, a
multivitamin is ALWAYS recommended.
_____ 9. The recommended dietary fiber intake range for adults 51 years old and above is
_____.
a. age plus 5 grams b. 10-15 grams
c. 21-30 grams
d. There are no fiber recommendations because elderly take fiber supplements.
_____ 10. Which of the following would NOT be considered a “high-quality” source of protein?
a. meat b. milk
c. eggs
d. wheat
e. All of the above are considered “high-quality” proteins.
_____ 14. Having a deficiency of which vitamin has been implicated in increased blood levels
of homocysteine in the elderly?
a. iron
b. folate
c. calcium
d. all the B vitamins and vitamin C e. fat-soluble vitamins only (A, D, E, K)
_____ 15. When may it be beneficial to recommend a vitamin or mineral supplement to an
elderly person?
a. when they experience loss of taste or smell b. when they have an illness causing a loss of appetite
c. when they are consuming a nutrient-dense diet
d. all of the above
e. a and b
_____ 16. A short-stature female (5’2”) was not consistently eating two or three meals a day. She usually had a piece of toast and coffee with cream and sugar at breakfast and
never could quite eat all of her home-delivered noon meal. What dietary supplement
would you recommend?
a. Multi-vitamin/mineral that is physiologically designed for elderly
b. Calcium supplement only c. Folate, vitamin B12 and iron only
d. Calcium and magnesium only
_____ 17. Recommendations for the macronutrients for the elderly are:
a. 40-60% of energy from carbohydrate, 25-35% of energy from fat, and between 1
and 1.3 grams/kilogram protein b. 35-55% of energy from carbohydrate, 20-35% of energy from fat, and between 1
and 1.3 grams/kilogram protein
c. 50-70% of energy from carbohydrate, 20-35% of energy from fat, and between 1
and 1.3 grams/kilogram protein.
d. 45-65% of energy from carbohydrate, 20-35% of energy from fat, and between 1 and 1.3 grams/kilogram protein.
e. 50-65% of energy from carbohydrate, 25-40% of energy from fat, and between 1
and 1.3 grams/kilogram protein.
_____ 18. Physical activity helps:
a. build lean body mass. b. maintain flexibility and balance.
c. improve aerobic capacity.
d. maintain health.
e. all of the above
_____ 19. When trying to promote healthy teeth and avoid cavities, what is important to
know?
a. Caramels & raisins are sticky and can wedge between teeth
b. Sipping slowly on soft drinks can increase bacterial growth
c. Coffee can break down enamel and cause wear and tear on teeth
d. All of the above e. a and b
Use the following case study to answer questions 20-23.
Mrs. Brown is 55 years old and 5 ft. 3 in. tall, with a medium frame. She reports having lost 20
pounds in the last 6 months and now weighs 130 pounds. She eats 2 meals a day and is complaining that food has lost its taste, and when she eats, she feels something sticking in her
throat, pain and discomfort; she has ill-fitting dentures that she does not wear very often.
_____ 20. What is Mrs. Brown’s BMI?
a. 17
b. 23 c. 26
d. 31
e. 34
_____ 21. According to the previous answer, Mrs. Brown’s BMI means she is: a. very underweight.
b. underweight.
c. normal weight.
d. overweight.
e. obese.
_____ 22. Mrs. Brown is at risk of nutritional deficiency due to:
a. her current BMI.
b. involuntary weight loss.
c. problems with dentures.
d. all of the above e. b and c only
_____ 23. What would be an appropriate amount of protein to recommend to Mrs. Brown if
she is eating 1,000 Calories per day?
a. 55 grams/day
b. 77 grams/day c. 88 grams/day
d. 100 grams/day
e. >100 grams/day
_____ 24. Which of the following statements is NOT true regarding theories of aging? a. free radical damage is known to promote chronic conditions including heart
disease, cataracts, and some cancers
b. scientists postulate that if they could shorten the telomeres of chromosomes
more slowly than happens naturally, cell senescence could be delayed
c. protein cross-links form because of exposure to high glucose levels, resulting in
adverse changes in tissue and organ function d. cells from long-lived species (such as humans) have higher Hayflick limits than
cells from shorter-lived species (such as mice or rats)
_____ 26. Which of the following is NOT one of the first steps to take in order to prevent constipation in older adults?
a. increase fluid intake
b. increase dietary fiber
c. use laxatives on a regular schedule
d. increase activity/exercise
_____ 27. The most common reason that vitamin B12 deficiency, or at least compromised B12
status, occurs in older adults is because
a. diets are frequently low in vitamin B12, since oral problems and financial
difficulties limit meat intake and meats are the best dietary sources of B12.
b. pernicious anemia is common in the elderly. c. malabsorption of vitamin B12 found naturally in foods is common in the elderly.
d. the elderly have a higher incidence of bacterial overgrowth which decreases
secretion of hydrochloric acid.
e. both c and d
_____ 28. Caloric restriction in animals has been shown to do all the following EXCEPT: a. decrease age-related diseases.
b. shorten lifespan.
c. cause them to live longer.
d. slow decline of muscle loss.
e. b and d
_____ 32. An overweight elderly woman with type 2 diabetes visited her health care provider.
When asked how her blood sugar control has been, the woman remarks, “Better
than ever.” What blood test could the provider order to verify this?
a. Hemoglobin
b. Hematocrit c. Hemoglobin A1C
d. Blood triglycerides
_____ 33. In four of five older people, diabetes occurs as one of several co-existing conditions.
Which of the following would NOT be considered one of these conditions? a. Hypertension
b. Heart disease
c. Obesity
d. Osteoporosis
e. Elevated blood lipids
_____ 34. Which of the following nutrient intakes is NOT a risk factor for osteoporosis?
a. ↓ Calcium intake
b. ↑ Alcohol intake
c. low body weight d. ↑ Iron intake
_____ 35. The best description of postmenopausal bone loss in women is _____.
a. slow, gradual bone losses
b. accelerated, marked bone losses
c. variable bone rate losses
d. none of the above
_____ 36. Which of the following has/have been shown to make bones weak?
a. Bed rest
b. Hospitalization c. Sedentary lifestyle
d. Resistance exercise
e. a, b, and c
_____ 39. A deficiency in vitamin B12 may lead to:
a. irreversible neurological damage. b. cognitive impairment.
c. constipation.
d. all of the above
e. a and b only
Short Answer
Lactation
1) Describe the 3 stages of lactogenesis
Stage 1) Milk formation begins and Colostrum is present which is almost a yellow fluid that is
very calorie and nutrient dense ( birth-2-5 days)
Stage 2) is when milk comes in, colostrum disappears and milk comes more fluidly and changes
in composition of calories and nutrients (2-5 days)
Stage 3) begins around 10 days and the milk composition is stable
2) Name 3 substances you should avoid ingesting when breastfeeding.
Should avoid alcohol if possible as it passes readily into breastmilk and is only gone after 2-3 hrs
per unit can pass readily to infant. Should avoid smoking as the nicotine content is 1.5-3 times
higher in breastmilk. Also amphetamines, cocaine, heroin and other restricted drugs should be
avoided during breastfeeding.
3) Which nutrients are affected by maternal diet
If mother has a high fatty acid diet then her breast milk will be high in fatty acid…high in
medium chain fatty acids.
Vitamin D in breastmilk is dependent on mothers exposure to sun
Vitamins B6 and B12 are water soluable vitamins that are dependent on the mothers diet. B12
deficiency is often seen in malnourished, vegan or women who have recently had gastric bypass
surgery.
4) What are the benefits of breastmilk versus formula
Breastmilk is highly beneficial for the mother and child, the child does not get overfed and is
given the right amount of nutrients needed for optimal growth and gets antibodies. However,
formula gives other people the option of feeding the baby and there are specialized formulas
which may be more beneficial if the child has a protein intolerance or is preterm
5) What are the benefits of breastfeeding for the mother and child
Mother is closeness with baby, may help you get back to pre-pregnancy weight and helps uterus
get back to pre-pregnancy size. Baby gets all of the nutrients optimally needed for human
growth, baby gets as much food as is needed and not more, baby receives anti-bodies from
mother which protects the baby from infections etc.
Infant
1) List 5 domains of development and describe the intrinsic and extrinsic influences on
development.
Motor, sensory, cognitive/mental, language, social/emotional.
Child’s health, brain function and temperament-Intrinsic
Family, environment-Extrinsic
2) Describe 2 cues of hunger and 2 cues of fullness that infants may express
Watching food being opened, irritation if feeding pace is too slow. Spitting out food, turns away
from food
3) Describe concerning patterns of growth
Does not gain weight (weight plateau’s), rapidly loses weight, rapidly gains weight (changes in
weight more than 2 significant lines on growth charts), head circumference does not change.
4) Describe changes in DRI’s from 0-6 months and 6-12 months
Change in protein needs from 2.2g/kg bw at 0-6 months to 1.6g/kg bw. Higher calorie need in the
6-12 month option but not kcal/bw. Changes from 108kcal/kg bw at 0-6months and 98kcal/kg in
0-6months. Fat does not change
5) Describe 2 allergens and the recommended consumption ages
Egg whites not until after 1 year of age or if there is a suspected allergy 2 yrs. Peanuts/peanut
butter not until after 1 years of age minimum
Toddlers/school age
1) Name and explain the different stages of treatment of obesity in preschoolers
Prevention Plus-Focus on behavior change with follow up
Structured weight management-planned diet and eating plan with physical activity, logs to
monitor behavior and food consumption. Follow up
Comprehensive multidisciplinary intervention-Weekly visits, food monitoring, short term diet
(aim of 1lb lost per month).
2) Name the 4 parenting styles and discuss which styles are related to obesity risk
Authoritarian-control foods, force foods, do what I say style…can increase obesity because of
external cues
Indulgent-child can eat what ever they want as the parent gives no restrictions…can cause
obesity because child most likely likes to eat sweet sugary foods.
Neglectful-parent is absent, no guidance or warmth towards the child so child will eat whatever
they can get to/whatever they want. Same as above
Authoritative-mix of warmth and guidance… provides what is offered and child determines
when it is eaten…least likely to develop obesity.
3) Describe 4 benefits of family meals with young children
Promotes diverse types of foods, learn to use internal signs of fullness, better quality diets and
better predictor or intelligence and academic performance later on.
4) Describe the thematic themes found in the study examining the implementation of NUTRIstep
within the clinical setting
-Parents changed childs behavior, feel good factor taught parents that what they were doing was
good, increased knowledge and awareness of nutrition for their child, it was a benchmark for
telling people about nutrition.
School Age
1) Define anaphylaxis and describe 3 recommendations for policies by health Canada
Allergic shock or allergic reaction. Avoidence is considered the only policy so the allergen should
not be brought into the school at all. The responsibility is on the parent and the parent should
identify the child to the school, identify treatment, be a part of policy initiation, teach the child to
take responsibility of their allergy too. All staff of the school should be trained in first aid which
includes treatment of allergic reaction.
2) What are the components of Ontario’s food and beverage policy
Green is supposed to be 80% and contains all nutrient dense foods such as whole grain bread and
lean meats.
Yellow is 20% of food in schools and is slightly higher in fat sodium and sugar and is things like
bagels and cheese.
Red should not appear in schools and is things high in fat, sodium and low nutrients such as
sweets, pop etc.
10 days a year anything is permitted to be sold.
3) List and describe the 4 stage process of treatment of obesity in children.
Same as earlier but also stage 4 of tertiary care interventions only for the very severely obese.
4) Ellen satter recommendations for physical activity
60 minutes plus of exercise. 3 days a week of intense exercise and 3 days a week of strength
training. Parents should provide a safe space for activity, promote family activity and limit tv
usage
Adolescence
1) State 2 symptoms/criteria for Anorexia and Bulemia
Anorexia is not maintaining a minimum normal body weight, fasting, distorted idea of fatness when
really thin. Binge eating…rapid consumption of food in a short period of time use of dieretics, laxatives
and vomiting to get ride of food.
2) Describe 3 reasons why vegetarianism may be of concern and describe 1 resource
More binge eating in vegetarians, adolescents use vegetarianism as a way to lose weight, also
may need extra supplementation because of lack of certain nutrients but are less likely to take
supplements. May use some vegetarian guides or the Vegetarian manifesto.
3) Describe 4 influences on health behavior in adolescence
Peers and role models, money/cost of food, watching TV/media, unhealthy options at school
4) Identify 4 differences in which males and females go through puberty. (or compare 3 ways in
which males and females go through puberty)
Males gain approximately 20lbs per year during puberty but females gain 18lbs. however men
drop their fat mass to approx. 12% whereas females higher it to 25%.
Women experience puberty earlier than men…starting at approx. 9 and finishing by about 14
whereas males may not start till 12 and finish at 16.
Grils peak height is at approximately 12 whereas males is approximately 14.
Early pubertal development in girls is associated with drug use, being sexually active, using
alcohol etc whereas late development for males is associated with negative consequences such as
steroid use.
Older adults
1) List 4 factors that can contribute to longevity
Limited/no alcohol use, non smokers, non-obese, social interaction, positive thinking, healthy
diet, cognitive stimulation.
2) List 4 nutrients of concern for older adults
Calcium, B12,
3) Describe how older adults age at different rates
Vigorous-very active older person who lives a full life.
Usual-Normal health concerns and patterns of ageing
Accelerated-Chronic and developing disease
4) Describe why older adults are at greater risk for B12 and calcium deficiency
More likely to have stomach problems that cannot split the B12 from its protein carrier so it
makes it malabsorbed by elderly bodies. Also takes years to develop a B12 deficiency and may
not have noticed that this was happening over the years
Calcium is lost due to bone decalcification also because of lack of absorption of Vitamin D which
helps calcium be absorbed
5) List 4 factors that can contribute to food insecurity in older adults.
Physical ability-are they actually able to get to the store to buy food or to prepare foods
Family support-are there people around to help them get food/prepare meals
Medication-people will forgoe food for medication
Eating alone-people dislike eating as it reminds them of being alone
