1. Mary is a 33-year-old recovering alcoholic who has end-stage liver disease. She complains that she’s gaining too much weight. “I’m never hungry so I only eat once a day.” Her usual weight last month was 120 pounds, but her current weight in clinic is now 155 pounds. What is likely to be the problem?
A. Mary’s anorexia and weight gain are due to early satiety from ascites.
B. Mary is not telling the truth and has been snacking.
C. Mary is pregnant.
D. Mary is gaining muscle mass because she stopped drinking alcohol.
ANSWER: A

2. John is three months post kidney transplant and has had type 2 diabetes for five years. His blood sugar is 55 mg/dl after his morning clinic appointment. What probably happened?
A. John’s insulin dose was not adjusted when his tacrolimus dose was tapered.
B. John ate a large pancake breakfast before coming to clinic.
C. John’s new kidney is clearing insulin out of his body at a faster rate.
D. John has an incisional wound abscess.
ANSWER: A

3. How does cardiac cachexia increase the risk of malnutrition?
A. Accelerated losses of salt and fluid increase blood flow to the gut.
B. The stomach empties faster when edema is present.
C. Gastrointestinal hypomotility may cause nausea, vomiting, and malabsorption.
D. More efficient use of energy is associated with more activity and leads to less time for eating.
ANSWER: C

4. Tomas is a 25-year-old American Indian who just received a kidney transplant. His dry BMI is 33 kg/m2, and both of his parents have diabetes. He spends his time reading or watching movies. After learning about his cyclosporine and corticosteroids, he expresses concerns about possible side effects such as weight gain and diabetes. What advice should you offer him?
A. Instead of watching movies, start walking 30 minutes every day for more exercise to help with weight control.
B. It’s OK to eat whatever you want to build yourself up after transplant; you won’t gain weight because you are young.
C. Your risk of developing diabetes after transplant is low because you are a Native American.
D. The transplant medicines you are taking will not cause high blood sugars; your risk of developing diabetes are only related to your family history and obesity.
ANSWER: A

5. Paul is one month post heart transplant. His blood sugars have been in the mid- to high-200s, his BMI is 22 kg/m2 after he lost 20 pounds since transplant, and he was recently discharged to an extended care facility for rehabilitation after a prolonged hospitalization. His immunosuppression medication was changed from calciuneurin inhibitors (CNI) to sirolimus to prevent renal dysfunction. He has an impacted tooth and needs oral surgery. What factors will affect his wound healing?
A. Paul is already one month beyond surgery, at a better weight, and receiving therapy to recover his strength. He will have no problems with wound healing.
B. Sirolimus, hyperglycemia, weight loss, and weakness from poor nutrition requiring rehabilitation will delay wound healing.
C. The switch from CNI to sirolimus to protect his kidneys will promote faster wound healing.
D. Improved cardiac function, weight loss, and rehabilitation therapy at the extended care center will facilitate accelerated healing.
ANSWER: B

6. Ben had a kidney transplant six months ago. His renal function is stable and all his blood values are normal according to his nephrologist. What kind of maintenance diet would you recommend to him?
A. Very low protein, very low sodium, low potassium, low phosphorus, fluid restricted to protect the kidney from wearing out
B. Normal protein without restriction, sodium controlled for good blood pressure, and low cholesterol for good heart health
C. High protein, high fat, high calorie for post surgery healing and extra energy for staying active
D. High protein, low potassium, low phosphorus because of immunosuppressive medications
ANSWER: B

7. Three common types of immunosuppressive medications are cyclosporine, tacrolimus, and corticosteroids. Which of the following are nutrition-related side effects of these medications?
A. Weight gain, osteoporosis, hypertension
B. Constipation, hypoglycemia, rickets
C. Dehydration, hyponatremia, hypermagnesemia
D. Dysphagia, anemia, anorexia
ANSWER: A

8. Mary is a 30-year-old woman three years post kidney transplant who developed new onset diabetes post transplant one year ago. She attended a family picnic in the late afternoon and ate shish kebabs and potato salad that had been served for lunch earlier in the day. She was the only person at the picnic who developed severe nausea, vomiting, and diarrhea when she got home. What food safety considerations should be observed to minimize foodborne illness for the immunosuppressed patient?
A. Washing hands carefully and maintaining correct temperature for cooking and storing food.
B. Eat food within 15 minutes of cooking and discard any uneaten food that has been sitting out for more than 30 minutes.
C. Make sure all foods are covered or individually wrapped.
D. Only serve commercially prepared foods that come in sealed packages, bottles, or cans.
ANSWER: A

9. Jim has chronic heart failure and has been waiting for a heart transplant for three weeks. Before he got sick, he weighed 200 pounds and had a BMI of 25 kg/m2. He was athletic and worked out daily. Now, he’s had too much fatigue and weakness from the heart failure and sleeps much of the time; he has lost muscle and gained 20 pounds. He eats only small amounts of food two times a day due to lack of appetite and bloating. What would you recommend for medical nutritional therapy to help him prepare for potential transplant?
A. Start total parenteral nutrition, as Jim is not able to meet his needs through oral intake alone.
B. Change to five or six small frequent feedings because of lack of appetite and bloating; provide high-calorie, high-protein foods to help with weight gain; and limit sodium to control fluid retention and blood pressure with heart failure.
C. No changes in current diet or eating habits are necessary. Jim was a little overweight, and weight loss will be better for his heart failure.
D. Encourage at least three feedings daily and offer high-calorie foods such as French fries, deli sandwiches with cheese, pastries, and other flavorful foods to encourage Jim to eat more to gain weight.
ANSWER: B

10. Jane is 48 and had a pancreas transplant seven years ago due to type 1 diabetes that had been diagnosed when she began grammar school. Her maintenance dose transplant immunosuppressive medications include tacrolimus and corticosteroids. She has gained 35 pounds since the transplant and now has a BMI of 31 kg/m2. Why is she at risk for developing new onset diabetes post transplant (NODPT)?
A. Jane has gained weight, now has a high BMI, and is taking immunosuppressive medications known to cause hyperglycemia.
B. Jane has no increased risk of developing NODPT because she has had a pancreas transplant.
C. Jane’s pancreas transplant might wear out after seven years.
D. The transplant immunosuppressive medications prevent rejection of her pancreas and are not associated with any side effect that would increase risk of high blood sugars.
ANSWER: A