Ch12 Exam Questions Providing Nutrition Services In Public

1. The most common nutrition-related diagnoses in primary care are hypertension, diabetes, normal pregnancy, heart disease and disorders of the lipid metabolism.

<Subject: Chapter 12>

<Complexity: Moderate>

2. Multiple factors hamper nutrition counseling as a part of primary care.

<Subject: Chapter 12>

<Complexity: Moderate>

3. The Put Prevention into Practice is a national program designed to better deliver preventative services.

<Subject: Chapter 12>

<Complexity: Moderate>

4. Under the Affordable Care Act nutrition services could not be included in preventative care.

<Subject: Chapter 12>

<Complexity: Moderate>

5. Time constraints and nutrition knowledge prevent some physicians from delivering nutrition counseling to clients.

<Subject: Chapter 12>

<Complexity: Moderate>

6. Reimbursement for medical nutrition therapy for RDs has few barriers.

<Subject: Chapter 12>

<Complexity: Moderate>

7. Disease Management Programs were created to help cut medical costs.

<Subject: Chapter 12>

<Complexity: Moderate>

8. In a PPO an insured person needs a referral to see a physician in their network.

<Subject: Chapter 12>

<Complexity: Moderate>

9. Medicare is available to Americans 55 and over.

<Subject: Chapter 12>

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10. There are more options for the homeless to get housing than in previous years.

<Subject: Chapter 12>

<Complexity: Moderate>

1. Chapter 12 is focused on the delivery of primary care. Which of the following statements is MOST accurate in describing primary care?
2. Primary care is comprehensive, preventative, and personal to the patient, but not something that is continuous throughout the life span.
3. Primary care may include registered dietitian nutritionists, dentists, social workers, and physicians, though physicians are the only necessary component.
4. Primary care is collaborative, both between various healthcare practitioners and between healthcare practitioners and the patient.
5. Primary care can be administered in public and/or private outpatient clinics, emergency rooms, addiction treatment centers, and also in the comfort of the patient’s home.

<Subject: Chapter 12 >

<Level of Difficulty: Easy>

1. In educating patients on nutrition practices, physicians or RDNs can save time and maintain effectiveness by utilizing which of the following combinations of tools and/or strategies:
   1. Telenutrition and photocopied excerpts from a nutrition textbook
   2. Shared medical appointments, followed by weekly individual appointments with the RDN to further target problem areas.
   3. Professional journal articles so that patients can understand the research behind the recommendations and individualized appointments with the RDN.
   4. Telenutrition and concise, creative messaging that highlights main messages.

<Subject: Chapter 12 >

<Level of Complexity: Moderate>

1. Mrs. Cooper is 66 years old and receives Medicare assistance. Because of the Affordable Care Act, Mrs. Cooper is eligible for additional preventative services at no cost. Mrs. Cooper is considered obese with a BMI of 35, but does not have kidney disease and suspects she might have diabetes, though it has never been diagnosed. Which of the following set of services are available to Mrs. Cooper at no charge?
2. Intensive group behavioral therapy for obesity and an oral health risk assessment
3. Osteoporosis screening and intensive group behavioral therapy for obesity
4. Dialysis support and alcohol misuse screening and counseling
5. Diabetes self-management training and cholesterol screening

<Subject: Chapter 12>

<Level of Complexity: Moderate>

1. American Indians and Alaskan Natives are especially susceptible to developing type 2 diabetes. The Indian Health Service (IHS) provides support of interventions to help those at-risk or living with diabetes. Based on what is known about best practices in working with this population, which of the following would be MOST effective for prevention of type 2 diabetes?
2. Engaging family, including caregivers, in planning for healthy eating and fitness activities for at-risk or diagnosed youth.
3. Screening for obesity in youth, but not in those that are overweight as they are not considered high risk.
4. Advocating for breast-feeding during the entire first year of life and longer, if able, for all postpartum women.
5. Collaborating with healthcare teams and educators to develop a school-based diabetes prevention program since that is where children are most of the day.

<Answer A>

<Subject: Chapter 12 >

<Level of Complexity: Difficult>

1. As was discussed in Chapter 12, homeless populations have specialized healthcare needs. All of the following needs to be considered in providing primary care to the homeless EXCEPT:
2. Provision of intensive weight loss counseling with a physical activity component.
3. Availability of mental health services
4. Providing information about Supplemental Nutrition Assistance Program (SNAP) benefits since you can participate in SNAP without a permanent address.
5. Prevention of communicable diseases, such as HIV/AIDS

<Subject: Chapter 12 >

<Level of Complexity: Moderate>

16. Providers of primary care include all of the below except:

1. Allopathic physicians or medical doctors (MDs) and osteopathic physicians or doctors of osteopathy (DOs)
2. Physician assistants (PAs)
3. Nurse practitioners (NPs)
4. Nutritionists/registered dietitians (RDs)
5. All are providers of primary care

<Subject: Chapter 12>

<Complexity: Moderate>

17. The most common nutrition-related diagnoses in 2000 were all of the following except:

1. Urinary tract infections
2. Essential hypertension
3. Routine infant or child health check
4. Type 2 diabetes mellitus
5. Normal pregnancy

<Subject: Chapter 12>

<Complexity: Moderate>

18. Primary care of newborns includes all of the following except:

1. Screening for PKU, sickle cell
2. Measuring head circumference periodically from birth to 2 months
3. Measuring height and weight periodically from birth to 18 years
4. Screening for anemia and lead blood levels at 1 year
5. Measuring urine specific gravity

<Subject: Chapter 12>

<Complexity: Moderate>

19. Physician confidence and skills in nutrition knowledge and counseling is deficient because of:

1. Physician’s time constraints
2. Cost
3. All of the above
4. None of the above

<Subject: Chapter 12>

<Complexity: Moderate>

20. Representative public health nutrition programs in primary care settings include all of the following except:

1. YMCA
2. Community Health Centers
3. Migrant Health Program
4. Public Housing Primary Care Program

<Subject: Chapter 12>

<Complexity: Moderate>

21. The most common nutrition-related diagnoses in primary care are hypertension, diabetes, normal pregnancy, heart disease, and ______________________.

A. Colon cancer

B. Disorders of the lipid metabolism

C. Osteoporosis

D. Arthritis

<Subject: Chapter 12>

<Complexity: Moderate>

22. Multiple factors hamper _______________ as a part of primary care.

A. Radiology

B. Nutrition counseling

C. Biochemical tests

D. None of the above

<Subject: Chapter 12>

<Complexity: Moderate>

23. The Put Prevention into Practice is a national program designed to better deliver _________________.

A. Congregate meals

B. Home meals

C. Preventative services

D. None of the above

<Subject: Chapter 12>

<Complexity: Moderate>

24. Under ___________, some nutrition services were included in preventative care.

A. Affordable Care Act

B. Democratic primary

C. Clinton Act

D. None of the above

<Subject: Chapter 12>

<Complexity: Moderate>

25. Time constraints and nutrition knowledge prevent some physicians from delivering _____________ to clients.

A. Dermatology services

B. Nutrition services

C. Dentistry

D. None of the above

<Subject: Chapter 12>

<Complexity: Moderate>

Questions 26–30 are from the case study:

Katherine is a 23-year-old female who resides in a public housing complex on the Southside of Chicago, Illinois. Katherine lives with her mother, grandmother, sister, and her sister’s two children in a two-bedroom apartment. Currently, Katherine works full-time as a clerk at the local gas station and does some babysitting for the neighborhood kids on the weekends. Her income helps to support the entire family. She is hoping to apply to the local community college for the upcoming fall semester.

Last week, Katherine missed her period and took a pregnancy test to find out that she is expecting. Although this news did not come at a great time as Katherine was separating from the baby’s father, she is planning to have the baby and wants to start prenatal care as soon as possible.

Katherine has not been to the doctor’s in almost eight years because she does not have health insurance. Her sister never received care while pregnant with her two children, but Katherine knows that she needs a primary care physician to help her in getting healthy for the baby. Already, Katherine is at a greater risk because of her BMI of 30, which is classified as obese, as well as her history of heavy drinking. Katherine vows that she wants to quit drinking, learn to eat a healthy diet, and start taking 15 minute walks each day. Katherine’s family cannot afford Internet or smart phones and the nearest library is 15 minutes away; therefore, she does not have the means to look up any information online that might help her in getting started on her goals.

On her way home from work, Katherine notices that her neighborhood has a new community health center, and she decides to stop in and make an appointment for the following week.

When Katherine meets with the primary care physician the next week, she receives a test to confirm the pregnancy (she is 6 weeks pregnant) and also has blood drawn for labs. The doctor is concerned, as her fasting blood glucose is 125 mg/dL, which is well over the normal fasting level (70 mg/dL or <). She also has elevated blood pressure. Both of these situations put Katherine at a high risk for complications during pregnancy.

Please answer the following questions based on Katherine’s case:

26. Currently, Katherine does not have health coverage; however, because she is low income, pregnant, and works for a small business that does not provide health care coverage, which of the following two insurance options is viable for Katherine, even if a small fee is required?

1. Medicare Part B or an HMOs
2. HMOs or private insurance through the healthcare.gov marketplace
3. Medicaid or private insurance through the healthcare.gov marketplace
4. Medicare + Choice (M +C) or Medicare Part B

<Subject: Chapter 12>

<Level of Difficulty: Difficult>

27. The physician working with Katherine refers her to a dietitian at the health center who only works part-time. Coordinating Katherine’s schedule with the dietitian’s has been very difficult. Which of the following is the BEST option for Katherine so that she can learn more about how to improve her nutrition status during pregnancy?

1. An online telenutrition session with the RDN.
2. A shared medical appointment with expectant moms at the health center, offered four times weekly.
3. RDN will visit Katherine at her home at Katherine’s convenience
4. Katherine can miss work to meet with the RDN because it is so important.

<Subject: Chapter 12>

<Level of Difficulty: Easy>

28. Katherine learns that the new community health center in her neighborhood was funded by a grant from the government. Which government agency and division likely funded this health center?

1. Health Resources and Services Administration: Bureau of Primary Health Care
2. Centers for Disease Control and Prevention: National Center for Chronic Disease Prevention and Health Promotion.
3. United States Department of Agriculture: Food and Nutrition Service
4. Agency for Healthcare Research and Quality: Center for Quality Improvement and Patient Safety

<Subject: Chapter 12>

<Level of Difficulty: Moderate>

29. The Patient Care and Affordable Care Act (ACA) made it possible for adults, women, and children to receive certain nutrition-related preventative services for free. Based on what we know about Katherine’s current health status and her health goals, which of the following group of services should Katherine consider receiving FIRST:

1. Obesity screening and counseling, osteoporosis screening and cholesterol screening
2. Gestational diabetes screening, breast-feeding comprehensive support and counseling, and anemia screening
3. Obesity screening and counseling, diabetes (type 2) screening for those with high blood pressure, and alcohol misuse screening and counseling
4. Alcohol misuse screening and counseling, cholesterol screening, and gestational diabetes screening

<Subject: Chapter 12>

<Level of Difficulty: Difficult>

30. Katherine learns that there may be additional services available to her as part of the Public Housing Primary Care (PHPC) Program. Which of the following statements is MOST accurate in describing the PHPC Program?

1. PHPC granted health centers use an integrated model to delivering primary health care, health promotion and disease prevention, but are not able to help residents with establishing eligibility for assistance.
2. PHPC grantees provide primary healthcare services, but this does not typically include dental care.
3. One goal of the PHPC is to provide training and funding for public housing residents who want to become nurses.
4. The mission of PHPC is to provide accessible, comprehensive healthcare and supportive service of which the Women, Infants, and Children (WIC) program may be one example.

<Subject: Chapter 12>

<Level of difficulty: Moderate>