Mahan: Krause's Food and the Nutrition Care Process, 13th Edition

Chapter 1: Digestion, Absorption, Transport, and Excretion of

Nutrients

MULTIPLE CHOICE

1. Absorption occurs in the stomach for which of the following nutrients?

a. Vitamins
b. Carbohydrates
c. Minerals
d. Alcohol

ANS: D
The stomach is the site of digestion of small amounts of lipid and protein.
Large proteins are broken down into peptides. Otherwise, the stomach
breaks down food into smaller particles and passes it into the small
intestine, where absorption of all nutrients EXCEPT alcohol takes place.
Alcohol is absorbed through the stomach.

2. Pepsinogen is converted to pepsin when it comes in contact with

a. enterokinase.
b. trypsinogen.
c. hydrochloric acid.
d. peptidases.

ANS: C
Pepsinogen is secreted in the stomach and converted to its active form by
the acid environment of the stomach. Enterokinase is secreted by the
brush border of the small intestine in response to presence of chyme.
Trypsinogen is secreted by the pancreas and activated by enterokinase.
Various peptidases are secreted by either brush border or the pancreas.

3. What is the function of enterogastrone?

a. Inhibits carbohydrate digestion
b. Enhances carbohydrate digestion
c. Enhances protein digestion
d. Inhibits gastric secretion and motility
ANS: D
 Enterogastrone is the hormone secreted by duodenal mucosa cells when
fat is present in the duodenum, thus slowing the delivery of fat from the
stomach and allowing time for fat digestion and micelle formation.
Carbohydrate digestion is enhanced or inhibited based on the form of the
carbohydrate (e.g., monosaccharide vs. fiber). Glucagon-like peptide 1 is
a hormone secreted in response to glucose intake, and it delays stomach
emptying and promotes satiety. Gastrin and cholecystokinin are hormones
that promote protein digestion through the stimulation of secretion of
pepsinogen and pancreatic proteolytic enzymes, respectively.

4. Which of the following is formed by bacterial synthesis in the colon?

a. Vitamin K
b. Vitamin D
c. Vitamin B6
d. Niacin

ANS: A
Colonic bacteria produce vitamin K, vitamin B12, thiamin, and riboflavin.
Vitamin D may be metabolized by exposure of precursor vitamin D in the
skin to ultraviolet light. The human body can synthesize niacin from the
amino acid tryptophan. Vitamin B6 must be obtained from dietary sources
such as meats, whole grains, vegetables, and nuts.

5. After surgical removal of a large portion of the small intestine,

what functional complication is most likely to develop?
a. Changes in dietary habits
b. Impaired digestion
c. Loss of absorptive tissue
d. Elimination of dietary residue

ANS: C
The small intestine is the primary site of nutrient absorption because of its
large absorption surface area. Secretions from the liver, gallbladder, and
pancreas can still contribute to digestion of intestinal contents. However,
decreased absorption of nutrients and food components may result in
more intestinal remains and residue. A patient may change dietary habits
as a result of gastrointestinal discomfort experienced after intestinal
resection, but this is not a functional complication.
 6. The sight or smell of food produces vagal stimulation of the parietal
cells of the gastric mucosa, resulting in the increased production of what?
a. Motilin
b. Hydrochloric acid
c. Cholecystokinin
d. Secretin

ANS: B
Parasympathetic innervation that causes release of hydrochloric acid
helps prepare the stomach for the potential of receiving food. After food
chyme is passed into the small intestine from the stomach, secretin and
cholecystokinin are secreted to stimulate pancreatic secretion of water
and bicarbonate. They also signal gallbladder contractions and colonic
motility, all resulting in reductions in stomach emptying and duodenal
motility. Motilin is secreted from the duodenal mucosa during fasting to
stimulate gastric emptying and intestinal motility.

7. If a patient experiences malabsorption of fat resulting from an

impaired ability to produce adequate bile salts for micelle formation, how
may fat absorption be improved?
a. By increasing short-chain fatty acids in the diet
b. By increasing medium-chain fatty acids in the diet
c. By increasing long-chain fatty acids in the diet
d. By restricting dietary intake of cholesterol

ANS: B
Medium-chain fatty acids of eight to 12 carbons can be absorbed directly
by mucosal cells without the presence of bile. The long-chain fatty acids
require micelle formation for absorption. Short-chain fatty acids result
from bacterial fermentation of malabsorbed carbohydrates and fibers. As
bile is produced from cholesterol, dietary restriction of cholesterol is
negligible in regard to improvements in fat absorption.

8. What is the function of secretin?

a. Stimulation of gastric secretions and increased motility
b. Stimulation of gallbladder contraction and the release of bile
c. Stimulation of the pancreas to secrete water and bicarbonate
 d. Stimulation of the parietal cells to secrete gastrin

ANS: C
Secretin is the hormone that works in opposition to gastrin. Whereas
gastrin stimulates stomach digestion activities, secretin decreases gastric
output and promotes pancreatic secretions to neutralize the acidity of
chyme. Cholecystokinin is also secreted when chyme enters the
duodenum, and it is responsible for stimulating the gallbladder.

9. Which intestinal hormone is released in the presence of fat and

glucose and results in delayed gastric emptying and satiety?
a. Glucose-dependent insulinotropic peptide (GIP)
b. Cholecystokinin (CCK)
c. Gastrin
d. Pancreatic lipase

ANS: A
GIP is released when glucose and fat are present in the small intestine and
stimulates insulin release. CCK secretion stimulates the pancreas to
release bicarbonate and some enzyme such as lipase. Gastrin stimulates
stomach digestion activities.

10. Which of the following is a list of enzymes released from the

pancreas?
a. Insulin, trypsin, and secretin
b. Lactase, isomaltase, and dextrinase
c. Protease, pepsin, and gastrin
d. Trypsin, chymotrypsin, and carboxypeptidase

ANS: D
Trypsin, chymotrypsin, and carboxypeptidase are three protein digestive
enzymes secreted by the pancreas. Insulin is an endogenous hormone
secreted by the pancreas. Secretin is a hormone secreted by the small
intestine. Lactase and isomaltase (also known as -dextrinase) are brush
border enzymes. Pepsin, which is a protease, and gastrin are hormones
secreted by the stomach.

11. In what form is dietary fat absorbed from the lumen of the intestine?
a. Chylomicron
 b. Micelle
c. Triglyceride
d. Lipoprotein

ANS: B
Fats must be emulsified into micelles so that they may cross the unstirred
water layer that borders the brush border membranes. These micelles
leave monoglycerides and fatty acids at the brush border, where they are
reabsorbed and reassembled as triglycerides. The triglycerides are
packaged with cholesterol, fat-soluble vitamins, and phospholipids into
chylomicrons, which pass into the lymphatic circulation. When these
reach the liver, the chylomicron components are repackaged into low-
density lipoproteins.

12. Which of the following is an advantage to using medium-chain

triglycerides when fat malabsorption occurs?
a. MCTs pass directly into the portal vein without
esterification.
b. MCTs pass directly into the lymphatic system without
esterification.
c. MCTs transport long-chain triglycerides through the lymph.
d. MCTs pass through the lymphatic system undigested.

ANS: A
In abetalipoproteinemia, chylomicron synthesis is impaired, which results
in impaired transport of fatty acids into the lymphatic circulation. Long-
chain fatty acids need to be reesterified into triglycerides for packaging
into chylomicrons. The benefit of use of MCTs is that they can bypass
lymphatic circulation and be directly transported to the liver.

13. By which transport mechanism are most vitamins absorbed from the
small intestine into the blood?
a. Passive diffusion
b. Active diffusion
c. Facilitative diffusion
d. Passive osmosis

ANS: A
 Passive diffusion is limited by the number of channels available for
nutrients to randomly pass through. Facilitated diffusion requires the
presence of carrier proteins, which may be limited by the health and
nutritional status of the person. Active transport requires energy, which
also may be limited by the person’s health and nutritional status. Osmosis
occurs in regard to concentration gradient and only involves the
movement of water, not vitamins.

14. What are primarily absorbed by the large intestine?

a. Water and fats
b. Carbohydrates
c. Proteins
d. Water and electrolytes

ANS: D
Water and electrolytes are usually the only absorbable remnants of dietary
intake that reach the large intestine. Fats, carbohydrates, and proteins
from the diet are absorbed throughout the small intestine.

15. What happens to cellulose and lignin as they go through the GI tract?
a. They are converted into glucose before absorption.
b. They are converted into glucose and absorbed by active
transport.
c. They are excreted in the feces unchanged.
d. They are excreted in the feces as glucose.

ANS: C
In humans, the secreted amylases cannot split the β1-2 and β1-4 linkages
between the saccharides within the cellulose molecule. As a result, no
individual glucose molecules are broken off.

16. Which is the process by which minerals are absorbed when they are
bound to an acid, organic acid, or amino acid?
a. Cotransportation
b. Carrier protein
c. Competitive inhibition
d. Chelation
ANS: D
Chelation refers to the binding of a cation mineral to a ligand, not a whole
protein. Cotransporters carry two different minerals at a time, such as the
case with sodium and phosphorus. An overlap of mineral transport
mechanisms may lead to competitive absorption between minerals in the
presence of other minerals, such as the case with iron or zinc
supplementation, leading to a decrease in copper absorption.

17. How often do the cells lining the intestinal tract recycle?
a. Every 2 to 3 days
b. Every 3 to 5 days
c. Every 5 to 7 days
d. Every 10 to 14 days

ANS: B
Intestinal mucosal cells have a life span of 3 to 5 days before they are
sloughed off and recycled. They are fully functional only for the last 2 to
3 days as they migrate to the distal third of the villi.

18. Which of the following bacterial genuses tend to occur the most
frequently in the adult colon?
a. Bacteroides
b. Escherichia
c. Lactobacilli
d. Helicobacter

ANS: A
Bacteroides spp. are the primary anaerobic colonic flora in adults.
Escherichia coli are predominant in the distal ileus. Lactobacilli are the
primary flora in infants’ gastrointestinal tracts until the introduction of
solid foods. Helicobacter pylori are acid-resistant bacteria that contribute
to gastritis and ulcer development.

19. What effect may be achieved by eating a diet high in prebiotic

carbohydrates?
a. Decreased SCFA production in the bowel
b. Increased growth of Lactobacilli spp.
 c. Decreased absorption of bile salts
d. Increased absorption of cation minerals

ANS: C
The use of prebiotic carbohydrates favors the growth of friendly bacteria
such as lactobacilli and bifidobacteria. These bacteria ferment the
prebiotic carbohydrates, promoting increased short-chain fatty acid
production. These types of carbohydrates have not been demonstrated to
have a bile-sequestering effect. Impairments in absorption of cation
minerals tend to be in relation to phytates and oxalates that are present in
plant foods.

20. How long does it take for small intestine contents to reach the
ileocecal valve?
a. 18 to 72 hours
b. 3 to 8 hours
c. 1 to 2 hours
d. 2 to 3 hours

ANS: B
Travel of contents through the small intestine takes 3 to 8 hours. A liquid
meal empties from the stomach within 1 to 2 hours of eating. A solid
meal takes 2 to 3 hours. Total transport, from mouth to anus, takes 18 to
72 hours on average.

Mahan: Krause’s Food and the Nutrition Care Process, 13th Edition

Chapter 6: Clinical: Inflammation, Physical and Functional Assessment

1. Height assessment on children younger than 2 to 3 years of age should be

performed

a. with the child recumbent.

b. using the arm span.
c. using a stationary meter.
d. using the sitting height.

ANS: A
 2. For infants and children under 3 years of age, recumbent length should be
determined by using a length board to measure the child from the crown
of the head to the heels of the feet. Arm span is an indirect measure of
height that may be used in adults who cannot stand or lie flat. For older
children and adults capable of standing, a stationary meter or statiometer
should be used. Sitting height may be used for children who are not
capable of standing.

Mid-upper arm circumference (MAC) combined with triceps skinfold

thickness (TSF) measurements provide information about

a. risk of obesity-related diseases.

b. measure of adiposity.
c. BMI.
d. arm muscle and arm fat area.

ANS: D

Although not commonly used in the acute care setting, measures of the MAC and
TSF in long-term care can provide information about a person’s arm muscle area
and arm fat area. These can be compared with percentile charts to determine the
person’s relative risk for undernutrition or can be tracked over time for changes in
the person’s nutritional status. One-time measures of these are not appropriate for
identifying body composition related to overall adiposity. Body mass index by
itself identifies the relative risk of obesity-related diseases.

3. During the assessment of nutritional status, which of the following is the

most objective measure?

a. Obtaining a dietary history

b. Evaluating biochemical tests
c. Observing meal consumption
d. Evaluating height and weight based on reference standards

ANS: B

Biochemical tests are considered to be the most objective and sensitive measures
of nutritional status. Subjective information is based on an individual’s responses,
observations, or interpretations. An iron deficiency may be suspected by reviewing
a patient’s diet history that seems to show little intake of iron-rich foods or
observing the eating of a foods that do not contain iron, but measurement of iron-
related blood parameters provides clear evidence that is not subject to debate.
Reference standards for height and weight are established based on cultural
interpretations of what levels are appropriate.

4. The skinfold sites most useful for measurement of body fat are

a. at the biceps and triceps.

b. below the scapula and above the biceps.
c. at the triceps and below the scapula.
d. at the iliac crest and the upper thigh.

ANS: C

Measurements of the triceps and subscapular skinfolds are the most useful for
evaluating body fatness because the most complete standards and methods of
evaluation are available for these two sites. Skinfolds at the biceps, iliac crest, and
upper thigh have also been used but have not been as thoroughly investigated as
the triceps and scapula.

5. Arm muscle area is determined by using

a. weight and height measurements.

b. triceps skinfold and weight measurements.
triceps skinfold and mid-upper arm circumference
c.
measurements.
d. mid-upper arm circumference and weight measurements.

ANS: C

Arm muscle area is determined based on the assumption that a cross-section of the
upper arm reflects two circles with the same center point, one within the other. The
outer circle is considered to be a layer of subcutaneous fat, and the inner circle is
considered to be the muscle. With knowledge of the overall MAC, the inner circle,
the AMA, can be estimated by subtracting the area between the two circles. This
area is related to the triceps skinfold.

6. Measurement of head circumference is useful as an indicator of

a. malnutrition in children younger than 3 years of age.

non-nutritional abnormalities in children younger than 3
b.
years of age.
c. nutritional deficiencies in children older than 3 years of age.
d. non-nutritional abnormalities in adults.

ANS: B

Up to the age of 3 years, head circumference is a measure of child growth and

brain growth. Any abnormalities or changes in the growth of head circumference
can be monitored. However, these abnormalities are not necessarily specific to
nutritional status. Undernutrition must be very severe to affect this growth.

7. ________ reorient(s) hepatic synthesis of plasma proteins and increase the

breakdown of muscle

a. Hormones
b. Prealbumin
c. Cytokines
d. Oxidants

ANS: C

Cytokines (interleukin-1, interleukin-6, tumor necrosis factor, and eicosanoids)

influence whole-body metabolism, body composition, and nutritional status.
Cytokines reorient hepatic synthesis of plasma proteins and increase the
breakdown of muscle protein to meet the demand for protein and energy during the
inflammatory response.

8. The Functional Nutritional Assessment includes assessment of tissue

reserves of key nutrients.

a. True
 b. False

ANS: A

The functional nutritional assessment focuses on early diagnosis and treatment of

nutritional problems associated with chronic disease including long-latency
nutritional insufficiencies. Assessment of nutrient tissue reserves is advocated with
this approach.

9. Which of the following can be used for assessing bone mineral density as
well as measuring fat and boneless lean tissue?

a. Bioelectrical impedance analysis

b. Magnetic resonance imaging
c. Computed tomography
d. Dual-energy x-ray absorptiometry

ANS: D

Dual-energy x-ray absorptiometry relies on passing an energy beam through

various tissue types, and based on the amount of energy lost, the amount or density
of the tissue can be measured. Bioelectrical impedance analysis conducts an
electrical charge through the body to measure the water content and thus lean
tissue of the body. Magnetic resonance imaging can be used to image the size of
body organs, the skeleton, and the amount and distribution of body fat. Computed
tomography images cross sections of the body, and from these, subcutaneous and
intraabdominal fat can be identified.

10.What physical examination technique is being used when a doctor listens for
bowel sounds?

a. Auscultation
b. Inspection
c. Palpation
d. Percussion

ANS: A
Auscultation involves the listening for various body sounds. Inspection refers to an
observation of a patient by using vision, smell, and hearing. Palpation involves
feeling the patient, such as when a pulse is determined. Percussion is the use of
sound to determine body organ borders, shape, or position. For example, to
determine the size of the liver, the physician will palpate around the right abdomen
to estimate the borders.

11. A patient who currently weighs 145 pounds weighed 180 pounds 3 months
ago. How would his current weight be assessed?

a. The patient is underweight.

b. The patient has significant weight loss.
c. The patient has severe malnutrition.
d. The patient has severe weight loss.

ANS: D

This patient has lost 35 pounds (180 – 145), which is about 19% of his original
weight in 3 months. Because this is greater than 7.5% weight loss, this is
interpreted as severe weight loss. Significant weight loss would be reflected by
losing exactly 7.5% of body weight in this same period of time. No information is
given in regard to the patient’s height or whether 180 pounds is his usual weight.
Therefore, determination of underweight cannot be made. If 180 pounds had been
his usual weight, 145/180 ´ 100% = 80% of UBW, which would be assessed as
moderate malnutrition.

12.An adult weighs 90 kg and is 1.83 m tall. This person’s BMI would be
classified as

a. underweight.
b. healthy weight.
c. overweight.
d. obese.

ANS: C

This person’s BMI would be calculated as 90/1.832 = 26.9 kg/m2. This value falls
into the overweight category, 25 to 29.9.
 13._______ is used to assess body composition using by measuring body
density.

a. Total body potassium measurement

b. Air displacement plethysmogram
c. Bioelectrical impedance analysis
d. Neutron activation analysis

ANS: B

Air displacement plethysmography relies on measurement of body density to

estimate body fat and fat-free mass. A “bod-pod” is a piece of equipment used for
this measurement.

14.In patients with fluid retention, what happens to biochemical indicators of

nutritional status, such as serum proteins and electrolytes?

a. They are increased because of increased urinary output.

b. They are decreased because of poor nutritional status.
c. They are increased because of hemoconcentration.
d. They are decreased because of hemodilution.

ANS: D

When a patient experiences fluid excess, such as may be associated with renal
failure or congestive heart failure, the excess fluid in the body will affect blood
measures by causing them to be lower. This is simply a reflection of the
concentration of the specific blood parameters in relation to the increased water in
the body. If a patient were dehydrated, the effect would be the reverse—the blood
values would increase because of relative concentration in less water in the body.

15.Which of the following is NOT a physical sign of overhydration?

a. Weight gain over 2 to 3 days

b. Peripheral edema
c. Decreased skin turgor
 d. Ascites

ANS: C

Short-term weight gain, peripheral edema, and ascites are all signs of
overhydration. Decreased skin turgor is associated with dehydration.

16.It can be argued that a functional nutrition assessment will better identify
why a patient is losing weight because:

a. it uses more advanced body composition techniques.

b. it includes assessment of gastrointestinal function.
c. tumor necrosis factor is used as a marker of weight loss.
d. it uses prealbumin rather than albumin for analysis.

ANS: B

Assessment of the capacity for digestion, absorption, and transport as well as

hormonal status provides critical background information as to why a patient may
be malnourished. Malabsorption syndrome, in which several nutrients are
abnormally absorbed, is the most dramatic. Constipation, diarrhea, excessive
vomiting, and flatulence also warrant further analysis. Mucosal changes in the
gastrointestinal (GI) tract are indicated by problems such as diarrhea and anorexia.
Tests may be done on a stool sample and can reveal excessive amounts of fat, an
indication of malabsorption, the status of the GI flora, and the amounts and types
of bacteria present in the gut.

17.A general estimate of desirable body weight for a woman who is 5’5” tall is.

a. 140 pounds
b. 125 pounds
c. 110 pounds
d. 115 pounds

ANS: B

Desirable body weight can be calculated using the Hamwi method of 100 pounds
for the first 5 feet of height and 5 pounds for each inch above 5 feet for women.
For men the calculation is 106 pounds for the first 5 feet of height and 6 pounds for
every inch above 5 feet.

18.A 19-year-old man weighs 75 kg and is 1.78 m tall. His BMI would be
interpreted as

a. underweight.
b. normal, healthy weight.
c. overweight.
one that needs to be plotted on a growth chart for
d.
interpretation.

ANS: D

The BMI calculation would be 75/1.782 = 23.7 kg/m2. However, because the man
is 19 years old, this BMI should be plotted on the growth chart comparing BMI
with age for males, 2 to 20 years of age. After being plotted, this man’s BMI would
be evaluated as being between the 50th and 75th percentiles of BMI for age.

19.Measurement of waist:hip ratio

has been implicated in the risk of developing cardiovascular

a.
disease.
b. is particularly useful in a hospital setting.
c. can be directly correlated with serum albumin.
has been implicated in the risk of developing Crohn’s
d.
disease.

ANS: A

Because fat distribution is an indicator of risk, circumferential or girth

measurements may be used. The presence of excess body fat around the abdomen
out of proportion to total body fat is a risk factor for ailments associated with
obesity and the metabolic syndrome.

Mahan: Krause’s Food and the Nutrition Care Process, 13th Edition

Chapter 7: Water, Electrolytes, and Acid-Base Balance

 1. Eating which of the following would most increase dietary potassium
intake?

a. Fruits and vegetables

b. Saltwater fish
c. Grains
d. Cereals

ANS: A

Fruits and vegetables tend to be the richest sources of dietary potassium, with a
number of them providing more than 300 mg per serving. Seafood, grains, and
cereals do not contribute nearly the same amount of potassium available in fruits
and vegetables.

2. When vasopressin is excessively secreted in the blood, which of the

following effects occurs?

a. Low serum potassium because water is retained

b. Low serum sodium because water is retained
c. High serum potassium because water is excreted
d. High serum sodium because water is excreted

ANS: B

Vasopressin, also known as antidiuretic hormone, stimulates renal reabsorption of

water. In syndrome of inappropriate diuretic hormone, excessive secretion of
vasopressin retains water and results in hyponatremia and low urine output.
Aldosterone is the hormone that stimulates renal sodium retention, and when
present, the kidneys excrete potassium in exchange for the sodium, which then
attracts the retention of water

3. What effect is of greatest concern in water intoxication?

a. Increased volume of the brain cells

b. Hypertension
c. Decreased circulating blood volume
d. Increased urinary output
ANS: A

When water intake exceeds the body’s ability to excrete it, such as with
impairment in kidney function, intracellular fluid volume increases. The increase
in the volume of brain cells results in headaches, nausea, blindness, vomiting, and
convulsions. Hypertension, decreased circulating blood volume, and changes in
urinary output tend to be associated with or the cause of hypovolemia.

4. For the average woman, _____ mL/day would meet fluid needs.

a. 1500
b. 1700
c. 2700
d. 3500

ANS: C

A daily allowance of water from all sources, including beverages and foods, is
about 2,700 mL per day for women and 3,700 mL per day for men. The general
recommendation for water intake is 1 mL/kcal eaten of 35 mL/kg body weight for
adults.

5. How does body water, as a percentage of body weight, change based on

stage of the life cycle and lifestyle?

Decreases significantly with age and is higher in athletes than

a.
non-athletes
Decreases significantly with age and is lower in athletes than
b.
non-athletes
Increases significantly with age and is higher in athletes than
c.
non-athletes
Increases significantly with age and is lower in athletes than
d.
non-athletes

ANS: A

At birth, an infant’s body weight is about 75% to 85% water compared with a lean
adult, who is 60% to 70% by body weight. As muscle mass decreases with age,
total body water also decreases. Also, compared with the lean adult, an obese adult
may be 45% to 55% water by body weight. This is because the weight is displaced
by adipose tissue, which contains very little water.

6. Where in the body is interstitial fluid located?

a. Within body cells and the lymphatic system

b. Within body cells
c. Between and around body cells
d. In the blood and the lymphatic system

ANS: C

The interstitial space is the spaces between and around the body cells, and it
contains the interstitial fluid. Fluid within body cells is known as intracellular
fluid. Fluid within the blood and lymphatic system is considered to be extracellular
fluid.

7. By what mechanism is thirst stimulated in the hypothalamus?

a. Increase in serum osmolality

b. Decrease in serum osmolality
Increase in both serum osmolality and in extracellular
c.
volume
Decrease in serum osmolality and an increase in extracellular
d.
volume

ANS: A

A decrease in extracellular fluid volume results in a hemoconcentration of the

blood, resulting in an increase in serum osmolality. The renin–angiotensin system
is triggered by the decreased extracellular volume, and as a consequence,
angiotensin II stimulates the thirst centers.

8. The kidneys compensate for a loss of body water by excreting

a. additional fluid and electrolytes.

b. additional electrolytes.
c. more concentrated urine.
 d. more dilute urine.

ANS: C

When water loss occurs, antidiuretic hormone secretion promotes renal

reabsorption of water as a means of conserving water in the body. As a result, the
urine that is excreted will be more concentrated with metabolites and electrolytes.
This can be evidenced by a darker urine that has a higher than normal specific
gravity.

9. The recommended fluid intake based on caloric intake is

a. 2 mL/kcal for adults and 3 mL/kcal for infants.

b. 0.5 mL/kcal for adults and infants.
c. 2 mL/kcal for adults and 1 mL/kcal for infants.
d. 1 mL/kcal for adults and 1.5 mL/kcal for infants.

ANS: D

Fluid intake of 1 mL/kcal for adults and 1.5 mL/kcal for infants provides about 35
mL/kg in adults and 150 mL/kg in infants. These levels help to maintain fluid
balance within humans.

10.For a normal healthy adult, fluid balance is achieved when the amount of
water taken in is

a. half the amount that is lost.

b. about equal to the amount lost.
c. twice the amount lost.
d. unrelated to the amount of water lost.

ANS: B

Water balance is achieved when the water taken into the body through food and
beverage sources and water produced through metabolic processes is equal to the
amount of water lost through urine, feces, sweat, and respiration. Excessive water
intake or losses results in water imbalance.

11.How does dehydration affect the specific gravity of urine?

 a. Specific gravity of urine increases above normal.
b. Specific gravity of urine does not change during dehydration.
c. Specific gravity of urine decreases below normal.
d. Specific gravity of urine undergoes a threefold increase.

ANS: A

Dehydration stimulates antidiuretic hormone activity, which promotes reabsorption

of water from the kidneys while still allowing for the excretion of electrolytes and
metabolites. This results in more highly concentrated urine. Because specific
gravity is a measure of the concentration of the urine, the specific gravity will
increase above normal.

12.Which of the following results from ingesting a large amount of sodium in a

short time?

a. Hypotension
b. Muscular cramps
c. Increased urinary calcium excretion
d. Increased urinary output of potassium

ANS: C

Persistent excessive sodium intake has been associated with the development of
hypertension and increased calcium excretion. Hypotension does not occur as
result of decreased sodium intake. Muscle cramping is more associated with
imbalances in calcium and magnesium intake. Increased urinary output of
potassium is a common side effect of the use of loop diuretics used in the control
of hypertension and fluid volume.

13.Which organ(s) maintain acid–base balance by the regulation of hydrogen

ions?

a. Lungs
b. Liver
c. Kidneys
d. Adrenal glands
ANS: C

Hydrogen ion excretion and retention is controlled through the kidneys. The
kidneys also contribute to acid–base regulation through the excretion and retention
of bicarbonate. The lungs are the other organs involved in acid–base regulation,
and they do so by controlling the expiration of carbon dioxide. The liver and
adrenal glands do not function in acid–base regulation, although their metabolic
activities may contribute to acid or base production.

14.What is the primary means by which hydrogen ions are generated in the
body?

a. Normal tissue metabolism

b. Ingestion of highly acidic foods
c. Oxidation-reduction reactions
d. Reabsorption of bicarbonate

ANS: A

Hydrogen ion and acid formation results from normal metabolism. All foods, not
just acidic ones, may result in the production of organic acids. Carbon dioxide is a
common volatile acid that results from oxidation of carbohydrates, fats, and
proteins. Bicarbonate is considered to be a base, and control of its concentration,
along with carbon dioxide concentrations, is a primary focus of acid–base
regulation.

15.Which of the following is a characteristic of metabolic acidosis?

a. Accumulation of bicarbonate
b. Decreased ventilation and retention of carbon dioxide
c. Accumulation of acids from abnormal metabolism
d. Excessive loss of carbon dioxide from the lungs

ANS: C

Metabolic acidosis is simply named for the production of acids through metabolic
processes. Diabetes ketoacidosis and lactic acidosis are two conditions that lead to
metabolic acidosis. Metabolic alkalosis results from an accumulation of
bicarbonate. Respiratory acidosis results from retention of carbon dioxide, but
respiratory alkalosis is associated with excessive carbon dioxide respiration.

16.Sodium is increased the most by the intake of

a. fresh vegetables.
b. frozen vegetables.
c. fresh meats.
d. luncheon meats.

ANS: D

One ounce of luncheon meat could provide 400 mg of sodium. Fresh meat
provides 30 mg of sodium per ounce if no salt, flavored salt, or flavor enhancers
are used. Fresh vegetables provide very little sodium, and processing 1 cup of
frozen vegetables without salt will provide about 10 mg of sodium.

17.In the extracellular space, what is the primary buffer system?

a. Phosphate
b. Bicarbonate and carbonic acid
c. Hydrogen
d. Protein

ANS: B

Bicarbonate and carbonic acid buffer the production of hydrogen ions and carbon
dioxide that results from cellular metabolism, and this occurs primarily in the
extracellular space. The phosphate buffering system and protein buffering are
activities that more commonly occur in the intracellular space.

18.Which acid–base imbalance can result from diuretics use, vomiting, and loss
of chloride?

a. Respiratory alkalosis
b. Respiratory acidosis
c. Metabolic alkalosis
d. Metabolic acidosis
ANS: C

Metabolic alkalosis results from a loss of acid, such as HCl through gastric
suctioning, and loss of extracellular fluid, such as would occur in diuretic use or
vomiting. Respiratory alkalosis occurs when excessive respiration occurs, such as
heavy breathing after exercise or in anxiety. Respiratory acidosis happens when
there is damage to the lungs or respiration that does not allow for the exchange of
carbon dioxide with oxygen. Metabolic acidosis results from medical conditions
that lead to a build-up of metabolic acids in the body.

19.What is the primary disturbance when respiratory alkalosis occurs?

a. Increased bicarbonate
b. Increased partial pressure of carbon dioxide
c. Decreased bicarbonate
d. Decreased partial pressure of carbon dioxide

ANS: D

Because respiratory alkalosis is associated with the excessive elimination of carbon

dioxide, the primary disturbance is a decrease in the partial pressure of carbon
dioxide in the blood. Respiratory acidosis would result in an increased partial
pressure of carbon dioxide. Metabolic alkalosis would be reflected by an increase
in bicarbonate, and metabolic acidosis would be evident with a decrease in
bicarbonate

20.How would the body compensate for metabolic acidosis?

a. Increased kidney excretion of bicarbonate

b. Increased ventilation of carbon dioxide
c. Decreased kidney excretion of bicarbonate
d. Decreased ventilation of carbon dioxide

ANS: B

When excessive metabolic production of acids occurs, the body compensates by

stimulating increased expiration of carbon dioxide to reduce acid concentrations in
the body. Whereas increased kidney excretion of bicarbonate would be the
compensation mechanism for dealing with respiratory alkalosis, decreased
excretion of bicarbonate would compensate for respiratory acidosis. In metabolic
alkalosis, the lungs would compensate by reducing expiration of carbon dioxide.