CNSC Module 1 Nutrition Assessment Exam
Questions And Correct Answers
/. Valproic acid has been shown to induce a deficiency in which of the following
nutrients?
A: Chromium
B: Carnitine
C: Leucine
D: Riboflavin - Answer-✅B: Carnitine
Valproic acid, an antiepileptic drug, has been shown to induce carnitine
deficiency. Carnitine is an essential cofactor in the metabolism of valproic acid
and ammonia elimination.Valproic acid depletes hepatic carnitine stores by
forming valproylcarnitine, which inhibits carnitine transport to the plasma
membrane. Consider carnitine replacement in patients with elevated ammonia
concentration, hepatotoxicity or valproate concentration above 450 mcg/mL.
Valproic acid also increases the metabolism of vitamin D and may reduce serum
levels. Chromium, leucine and riboflavin do not appear to be affected by valproic
acid therapy.
/.After a significant intestinal resection, which of the following areas of the
gastrointestinal tract has the LEAST impact on nutrient absorption and intestinal
adaptation?
A: Colon
B: Ileum
C: Jejunum
D: Ileocecal valve - Answer-✅C: Jejunum
Resections of the proximal bowel, including the duodenum and proximal jejunum,
are generally better tolerated because of ileal compensation and adaptation. In
general, ileal resection is poorly tolerated because adaptive hyperplasia in the
remaining jejunum is limited. The ileocecal valve slows intestinal transit allowing
for greater absorption of nutrients. The colon has critical roles in fluid and nutrient
absorption. Therefore, patients lacking a colon are at greater risk of dehydration.
Furthermore, the colon is capable of salvaging calories through anaerobic
bacterial fermentation of undigested carbohydrates into absorbable short-chain
fatty acids (SCFAs).
,/.A patient has been NPO and receiving parenteral nutrition (PN) due to severe
paralytic ileus. PN has been providing 300 g of dextrose, 90 g amino acids and
total calories of 1380 kcal for the last 3 weeks. Patient has also been getting IV
multivitamin and multitrace elements according to hospital protocol. During
assessment, the clinician notes signs of diffuse scaly dermatitis, hair loss and
biochemical results of anemia and thrombocytopenia. Which nutrient deficiency
should be diagnosed?
A: Vitamin D
B: Essential fatty acids
C: Vitamin E
D: Iron - Answer-✅B: Essential fatty acids
The patient has been receiving PN without lipids for three weeks, which has
resulted in essential fatty acid deficiency (EFAD). EFAD usually results after 4
weeks of PN, although signs of deficiency can be seen as early as 10-20 days in
adults and deficiency can occur more rapidly in infants and children. Signs of
EFAD include scaly dermatitis, alopecia, thrombocytopenia, anemia and impaired
wound healing. Diagnosis can be confirmed with a triene:tetraene ratio greater
than 0.2. It is recommended to provide 1% to 4% of total energy from linoleic acid
(LA) and 0.25% to 0.5% from alpha-linolenic acid (ALA) in order to prevent
EFAD. Trace element deficiencies need to be monitored in the light of shortages.
Using ASPEN dosing guidelines should reduce the risk. Symptoms of vitamin D
deficiency are muscle weakness, fatigue, bone pain and depression. Vitamin E
deficiency results in numbness and tingling, muscle weakness and impaired
coordination. Iron deficiency typically results in pallor, fatigue, and microcytic
anemia. Iron is not included in standard multitrace element preparations
manufactured in the United States due to concerns for increased microbial
growth. If iron deficiency is expected, either oral, enteral, or parenteral iron
supplementation should be considered. Iron dextran is the most compatible with
PN.
/.When conducting a nutrition focused physical exam (NFPE), which of the
following is an indicator of severe muscle loss?
A: Hollowing depression of the temporalis muscle
B: Rounded curves at the arm and shoulder
C: Slightly depressed interosseous muscle
D: Somewhat prominent iliac crest - Answer-✅A: Hollowing depression of the
temporalis muscle
Muscle loss in a patient with severe malnutrition can be identified when
conducting an NFPE. The temporalis muscle will have a hollowing, scooping
depression. The clavicle and acromion bone region/deltoid muscle will appear
square with very prominent bones. The interosseous muscle on the dorsal hand
, will appear depressed between the thumb and forefinger. A prominent iliac crest
pertains to subcutaneous fat loss, not muscle loss.
/.Which of the following nutrition tools includes evaluating subcutaneous fat and
muscle wasting at multiple body sites to determine nutrition status?
A: Nutrition risk index (NRI)
B: Nutrition Risk in Critically Ill (NUTRIC)
C: Subjective Global Assessment (SGA)
D: Nutrition Risk Score (NRS-2002) - Answer-✅C: Subjective Global
Assessment
The SGA is a nutrition assessment tool using five historical criteria (weight
history, dietary intake, gastrointestinal symptoms, functional status, and
metabolic demand) and three components focusing on physical examination (fat
depletion, muscle wasting, and nutrition related edema). The data are
subjectively weighted to classify the patient as well nourished, moderately
malnourished, or severely malnourished. The SGA has been found to be a good
predictor of complications in patients undergoing gastrointestinal surgery, liver
transplantation, and dialysis. For critically ill patients, the SGA may have limited
use. The NRS-2002 includes unintentional weight loss, BMI, disease severity,
impaired general condition and age > 70. The NUTRIC score includes APACHE
II score, SOFA (with or without IL-6), number of comorbidities and days from
hospital to ICU admission. The NRI uses serum albumin and the ratio of current
weight to usual weight.
/.Which of the following is a clinical symptom of the syndrome of inappropriate
antidiuresis (SIAD)?
A. Increased urinary output
B. Increased urinary sodium
C. Hypernatremia
D. Decreased urinary osmolality - Answer-✅B. Increased urinary sodium
SIAD (formerly known as the syndrome of inappropriate antidiuretic hormone or
SIADH) is one of the most common causes of hyponatremia. It is a disorder of
sodium and water balance caused by the inappropriate release of antidiuretic
hormone (ADH). The result is an increase in total body water which causes a
dilutional hyponatremia. Increased sodium concentrations and osmolality are
seen in the urine due to excessive water reabsorption. To compensate for
expansion of extracellular fluid, aldosterone secretion is inhibited while atrial
natriuretic peptide (ANP) increases. Compensatory responses serve to maintain
euvolemia, but at the same time further worsen hyponatremia. Standard
treatment typically involves restricting fluid intake and increasing sodium intake, if
the patient has symptomatic hyponatremia. If these interventions are ineffective,
Questions And Correct Answers
/. Valproic acid has been shown to induce a deficiency in which of the following
nutrients?
A: Chromium
B: Carnitine
C: Leucine
D: Riboflavin - Answer-✅B: Carnitine
Valproic acid, an antiepileptic drug, has been shown to induce carnitine
deficiency. Carnitine is an essential cofactor in the metabolism of valproic acid
and ammonia elimination.Valproic acid depletes hepatic carnitine stores by
forming valproylcarnitine, which inhibits carnitine transport to the plasma
membrane. Consider carnitine replacement in patients with elevated ammonia
concentration, hepatotoxicity or valproate concentration above 450 mcg/mL.
Valproic acid also increases the metabolism of vitamin D and may reduce serum
levels. Chromium, leucine and riboflavin do not appear to be affected by valproic
acid therapy.
/.After a significant intestinal resection, which of the following areas of the
gastrointestinal tract has the LEAST impact on nutrient absorption and intestinal
adaptation?
A: Colon
B: Ileum
C: Jejunum
D: Ileocecal valve - Answer-✅C: Jejunum
Resections of the proximal bowel, including the duodenum and proximal jejunum,
are generally better tolerated because of ileal compensation and adaptation. In
general, ileal resection is poorly tolerated because adaptive hyperplasia in the
remaining jejunum is limited. The ileocecal valve slows intestinal transit allowing
for greater absorption of nutrients. The colon has critical roles in fluid and nutrient
absorption. Therefore, patients lacking a colon are at greater risk of dehydration.
Furthermore, the colon is capable of salvaging calories through anaerobic
bacterial fermentation of undigested carbohydrates into absorbable short-chain
fatty acids (SCFAs).
,/.A patient has been NPO and receiving parenteral nutrition (PN) due to severe
paralytic ileus. PN has been providing 300 g of dextrose, 90 g amino acids and
total calories of 1380 kcal for the last 3 weeks. Patient has also been getting IV
multivitamin and multitrace elements according to hospital protocol. During
assessment, the clinician notes signs of diffuse scaly dermatitis, hair loss and
biochemical results of anemia and thrombocytopenia. Which nutrient deficiency
should be diagnosed?
A: Vitamin D
B: Essential fatty acids
C: Vitamin E
D: Iron - Answer-✅B: Essential fatty acids
The patient has been receiving PN without lipids for three weeks, which has
resulted in essential fatty acid deficiency (EFAD). EFAD usually results after 4
weeks of PN, although signs of deficiency can be seen as early as 10-20 days in
adults and deficiency can occur more rapidly in infants and children. Signs of
EFAD include scaly dermatitis, alopecia, thrombocytopenia, anemia and impaired
wound healing. Diagnosis can be confirmed with a triene:tetraene ratio greater
than 0.2. It is recommended to provide 1% to 4% of total energy from linoleic acid
(LA) and 0.25% to 0.5% from alpha-linolenic acid (ALA) in order to prevent
EFAD. Trace element deficiencies need to be monitored in the light of shortages.
Using ASPEN dosing guidelines should reduce the risk. Symptoms of vitamin D
deficiency are muscle weakness, fatigue, bone pain and depression. Vitamin E
deficiency results in numbness and tingling, muscle weakness and impaired
coordination. Iron deficiency typically results in pallor, fatigue, and microcytic
anemia. Iron is not included in standard multitrace element preparations
manufactured in the United States due to concerns for increased microbial
growth. If iron deficiency is expected, either oral, enteral, or parenteral iron
supplementation should be considered. Iron dextran is the most compatible with
PN.
/.When conducting a nutrition focused physical exam (NFPE), which of the
following is an indicator of severe muscle loss?
A: Hollowing depression of the temporalis muscle
B: Rounded curves at the arm and shoulder
C: Slightly depressed interosseous muscle
D: Somewhat prominent iliac crest - Answer-✅A: Hollowing depression of the
temporalis muscle
Muscle loss in a patient with severe malnutrition can be identified when
conducting an NFPE. The temporalis muscle will have a hollowing, scooping
depression. The clavicle and acromion bone region/deltoid muscle will appear
square with very prominent bones. The interosseous muscle on the dorsal hand
, will appear depressed between the thumb and forefinger. A prominent iliac crest
pertains to subcutaneous fat loss, not muscle loss.
/.Which of the following nutrition tools includes evaluating subcutaneous fat and
muscle wasting at multiple body sites to determine nutrition status?
A: Nutrition risk index (NRI)
B: Nutrition Risk in Critically Ill (NUTRIC)
C: Subjective Global Assessment (SGA)
D: Nutrition Risk Score (NRS-2002) - Answer-✅C: Subjective Global
Assessment
The SGA is a nutrition assessment tool using five historical criteria (weight
history, dietary intake, gastrointestinal symptoms, functional status, and
metabolic demand) and three components focusing on physical examination (fat
depletion, muscle wasting, and nutrition related edema). The data are
subjectively weighted to classify the patient as well nourished, moderately
malnourished, or severely malnourished. The SGA has been found to be a good
predictor of complications in patients undergoing gastrointestinal surgery, liver
transplantation, and dialysis. For critically ill patients, the SGA may have limited
use. The NRS-2002 includes unintentional weight loss, BMI, disease severity,
impaired general condition and age > 70. The NUTRIC score includes APACHE
II score, SOFA (with or without IL-6), number of comorbidities and days from
hospital to ICU admission. The NRI uses serum albumin and the ratio of current
weight to usual weight.
/.Which of the following is a clinical symptom of the syndrome of inappropriate
antidiuresis (SIAD)?
A. Increased urinary output
B. Increased urinary sodium
C. Hypernatremia
D. Decreased urinary osmolality - Answer-✅B. Increased urinary sodium
SIAD (formerly known as the syndrome of inappropriate antidiuretic hormone or
SIADH) is one of the most common causes of hyponatremia. It is a disorder of
sodium and water balance caused by the inappropriate release of antidiuretic
hormone (ADH). The result is an increase in total body water which causes a
dilutional hyponatremia. Increased sodium concentrations and osmolality are
seen in the urine due to excessive water reabsorption. To compensate for
expansion of extracellular fluid, aldosterone secretion is inhibited while atrial
natriuretic peptide (ANP) increases. Compensatory responses serve to maintain
euvolemia, but at the same time further worsen hyponatremia. Standard
treatment typically involves restricting fluid intake and increasing sodium intake, if
the patient has symptomatic hyponatremia. If these interventions are ineffective,
