1. The Scope of Practice encompasses the range of roles, activities, and regulations within which nutrition and dietetics practitioners perform.
a.
True
b.
False
ANSWER:
REFERENCES:
The Registered Dietitian Nutritionist1 in Clinical Practice
KEYWORDS:
Bloom's: Understand
2. Hospice facilities focus on integrated, multidisciplinary assistance for recovery from acute or chronic illness and/or surgical procedures.
Bloom's: Remember
3. With a minimum of 1,000 hours of related practice and at least 90 continuing education credits, a registered dietitian may become a lactation consultant.
Other Health Professionals—Interdisciplinary Teams
4. Physicians are commonly responsible for the initial nutrition screening of patients and for notifying the dietitian if a patient's food intake is inadequate.
5. Some states provide Medicaid benefits for nutrition services, but there is significant variability between states.
Health Care Services and Reimbursement for Medical Nutrition Therapy (MNT)
6. To provide optimal nutritional care, all aspects of a patient's life must be considered.
Developing Clinical Skills and Professional Performance
7. Evidence-based practice can best be defined as purposeful, self-regulatory judgment that results in interpretation, analysis, evaluation, and inference upon which that judgment is based.
8. The cognitive processes that a dietitian goes through to make clinical judgments are known as practice standards.
9. The steps of the decision-making process do not necessarily take place in a particular sequence.
10. The AND's Code of Ethics and Standards of Professional Performance require that outcomes are measurable and evidence-based.
11. A hospital that is owned or managed by the community or a religious organization rather than by a group of investors is classified as:
private profit
veterans/military
c.
private not for profit
d.
public not for profit
e.
public for profit
c
12. Which of the following is an example of a tool used by a dietitian to track his or her professional progress as part of the Practice Management and Advancement Standard?
Scope of Practice for the RD and DTR
CDR Professional Development Portfolio
Nutrition Care Process Reference Manual
Academy Definition of Terms List
Dietetics Career Development Guide
b
13. Reviewing productivity reports, hiring and training employees, and developing policies are all major tasks of the:
clinical nutrition manager
dietetic assistant
clinical dietitian
diet clerk
dietetic technician
a
14. Processing diet orders, checking menus against standards, and setting up standard nourishment are all major tasks of the:
registered dietitian nutritionist
d
15. Which of the following is an advantage of working as a registered dietitian in a long-term care facility over other settings?
shorter working hours because of decreased need for services
more leadership positions available among health professionals at the same facility
flexibility to take paid holidays and time off on weekends
the outcomes of each nutrition intervention do not have to be monitored
greater autonomy and can set flexible schedules
e
16. One primary role of the pediatric RDN is to:
provide information about community resources for nutrition services
educate children about maintaining an appropriate diet for their age
assist pediatric patients with performing activities of daily living
optimize nutrient intake in children while promoting growth and development
assess for and prescribe enteral feedings and total parenteral nutrition
17. A registered dietitian is assessing a patient who reports that it is challenging to eat because she cannot pick up a fork or knife. Who would the RD consult with regard to this issue?
physical therapist
occupational therapist
nurse
social worker
18. In a neurological setting where swallowing disorders are common, the dietitian would have to work closely with which member of the interdisciplinary team?
pharmacist
speech-language pathologist
19. Which professional would most likely be involved with changing the amount of nutrients delivered via parenteral nutrition support?
20. A patient needs assistance with buying food after he is discharged from the hospital. Which professional should be consulted?
physician
21. A patient needs a prescription for total parenteral nutrition to ensure adequate electrolyte balance. This is the responsibility of a:
22. A patient reports to a hospital that he has difficulty in breathing. Which of the following professionals should he consult?
respiratory therapist
23. Investor-owned health care organizations are classified as:
veterans or military
private for profit
24. Under the Affordable Care Act (ACA), nutrition services are expected to expand. Why is this?
Dietitians will need to conduct fewer screening exams.
There will be a decreased need for treatment of malnutrition.
There will be more requirements for preventative services.
Families will be required to pay for nutrition services.
Individual state programs will no longer serve low-income Americans.
Bloom's: Apply
25. The dietitian's knowledge base:
is fulfilled upon graduation from an accredited school
remains at a level of minimum standards based on the Accreditation Standards for Didactic Programs in Nutrition
constantly expands and evolves in order to apply to new practice developments
is diminishing because of current evidence-based practices
is considered insufficient until she/he has finished a dietetics internship
Bloom's: Analyze
26. One step used in the scientific method competency is to:
assess all options before collecting data
weigh all options against standard sets of criteria
consider the consequences of a decision
test the hypothesis through experimentation
make a final conclusion
27. The dietitian's continuing education and reflection on the practice are examples of which component of critical thinking?
specific knowledge base
experience
competence
attitudes
intellectual standards
28. Which of the following components of critical thinking involves learning from observing, listening to patients, and interacting with other health professionals?
diagnostic reasoning
29. Which of the following components of critical thinking involves the ability to identify a nutrition-related problem and make decisions regarding the most appropriate nutrition-related solution?
medical problem solving
standards
30. The decision-making process includes:
identifying a phenomenon
formulating a hypothesis
weighing each option against a set of criteria
testing a hypothesis through experimentation
evaluating a hypothesis
31. A dietitian has completed an assessment of a patient and determined that her daily intake needs are not met. Based on a research article, the dietitian replaces one of the nutrition supplements in her diet. A few days later, the dietitian observes improvement in the patient's health. Which component of critical thinking best describes the given scenario?
evidence-based dietetics practice
specific knowledge base practice
decision making
attitude
32. The incorporation of systematically reviewed scientific findings into food and nutrition practice is known as:
scientific inquiry
research methods
evidence-based practice
continuing education
data-driven analysis
33. What is a systematically developed statement based on scientific evidence that assists practitioner and patient decisions about appropriate health care for specific clinical circumstances?
guideline
diagnostic
evidence-based rule
scientific analysis
decision report
34. What term refers to a series of clinical judgments that result in an informal judgment or a formal diagnosis?
problem solving
critical thinking
35. A patient has cirrhosis of the liver. The dietitian plans specific nutrition interventions for her and continues to monitor her and observe for clinical and laboratory values that are consistent with cirrhosis. This type of thinking is most reflective of:
risk taking
36. A clinical dietitian attends a nutrition conference and another dietitian presents her research in a specific area of nutrition science. The clinical dietitian then implements what she has learned into practice at her facility. This is an example of:
outcomes research
nutritional diagnosis
the nutrition coding process
the decision-making process
37. The dietitian's values, fairness, and responsibility in reaching solutions are most indicative of which component of critical thinking?
38. Which of the following facilities focuses on relieving symptoms and supporting a life expectancy of six months or less?
adult day care
residential living
skilled nursing
long-term acute care
hospice
39. Evaluation of care that focuses on the status of participants after receiving care is known as:
the scientific method
40. Standards of Professional Performance requires:
evidence-based evaluation of outcomes
utilizing personal beliefs to make decisions
continuous education to promote effective practice
limited use of clinical education and extensive personal knowledge
an understanding of values and beliefs
41. Nutritional screening of patients to determine the risk of developing a nutrition-related problem, nutrition intervention, and evaluation of the nutrition care plan are all major tasks performed by the:
dietetic technician (DTR)
42. The clinical practice of a dietitian at the highest level will most likely involve:
avoiding the use of critical thinking for decision-making
consulting authorities during decision making
anticipating possible outcomes and identifying a broader range of options
assumptions that the judgments of more seasoned dietitians are correct
following rules set forth by authorities
43. An entry-level dietitian's level of critical thinking will most likely involve:
assuming that the judgments of more seasoned dietitians are correct
disconnecting from authorities and using one's own judgment
allowing others to make critical decisions until the dietitian is in a managerial position
44. Ms. Lopez is a widowed 68-year-old Nicaraguan woman and an immigrant who has lived in the United States for ten years. She lives in the second floor of a walk-up apartment with her daughter and son-in-law and their four children. Ms. Lopez is admitted to the hospital, is diagnosed with a stroke, and has weakness in her left side. She complains of coughing when she drinks and feels that food sometimes gets caught in her throat. She has diabetes and high blood pressure and is on several oral medications. She does not, however, check her blood sugar levels regularly because she does not feel comfortable pricking her finger. Her body mass index (BMI) is 33. Ms. Lopez is undocumented and uninsured.
Assessing whether Ms. Lopez's left-sided weakness is affecting her ability to perform activities of daily living is the job of which member of the interdisciplinary team?
PREFACE NAME:
Ms. Lopez
45. Ms. Lopez is a widowed 68-year-old Nicaraguan woman and an immigrant who has lived in the United States for ten years. She lives in the second floor of a walk-up apartment with her daughter and son-in-law and their four children. Ms. Lopez is admitted to the hospital, is diagnosed with a stroke, and has weakness in her left side. She complains of coughing when she drinks and feels that food sometimes gets caught in her throat. She has diabetes and high blood pressure and is on several oral medications. She does not, however, check her blood sugar levels regularly because she does not feel comfortable pricking her finger. Her body mass index (BMI) is 33. Ms. Lopez is undocumented and uninsured.
Assessing whether Ms. Lopez has any difficulty in swallowing is the job of which member of the interdisciplinary team?
46. Ms. Lopez is a widowed 68-year-old Nicaraguan woman and an immigrant who has lived in the United States for ten years. She lives in the second floor of a walk-up apartment with her daughter and son-in-law and their four children. Ms. Lopez is admitted to the hospital, is diagnosed with a stroke, and has weakness in her left side. She complains of coughing when she drinks and feels that food sometimes gets caught in her throat. She has diabetes and high blood pressure and is on several oral medications. She does not, however, check her blood sugar levels regularly because she does not feel comfortable pricking her finger. Her body mass index (BMI) is 33. Ms. Lopez is undocumented and uninsured.
The dietitian assessed Ms. Lopez and identified the potential problem with her food and fluid intake. Which of the following components of critical thinking best describes this situation?
47. Ms. Lopez is a widowed 68-year-old Nicaraguan woman and an immigrant who has lived in the United States for ten years. She lives in the second floor of a walk-up apartment with her daughter and son-in-law and their four children. Ms. Lopez is admitted to the hospital, is diagnosed with a stroke, and has weakness in her left side. She complains of coughing when she drinks and feels that food sometimes gets caught in her throat. She has diabetes and high blood pressure and is on several oral medications. She does not, however, check her blood sugar levels regularly because she does not feel comfortable pricking her finger. Her body mass index (BMI) is 33. Ms. Lopez is undocumented and uninsured.
The dietitian recommends a soft food diet and requests the physician to order a swallowing study for Ms. Lopez. After 24 hours of the diet, the dietitian checks with the staff to determine if Ms. Lopez has been finishing her food and contacts the physician to determine the outcome of the swallowing study. This process of monitoring and following up best illustrates:
scientific reasoning
48. Ms. Lopez is a widowed 68-year-old Nicaraguan woman and an immigrant who has lived in the United States for ten years. She lives in the second floor of a walk-up apartment with her daughter and son-in-law and their four children. Ms. Lopez is admitted to the hospital, is diagnosed with a stroke, and has weakness in her left side. She complains of coughing when she drinks and feels that food sometimes gets caught in her throat. She has diabetes and high blood pressure and is on several oral medications. She does not, however, check her blood sugar levels regularly because she does not feel comfortable pricking her finger. Her body mass index (BMI) is 33. Ms. Lopez is undocumented and uninsured.
The dietitian recommends a soft food diet and the physician has ordered a swallowing study for Ms. Lopez. After 24 hours on the diet, the dietitian finds that Ms. Lopez has difficulty in following the diet and nutritional supplements. The dietitian plans the diet menu in such a way that Ms. Lopez starts responding to the new diet positively. The response of the dietitian best describes which attitude?
creativity
confidence
perseverance
precision
49. Of those insured Americans under age 65, what percent of people have private insurance?
15%
13%
46%
64%
78%
50. The attitude of thinking independently is best demonstrated by:
listening to both sides of a discussion
admitting limitations
asking for help when needed
not settling for quick solutions
basing decisions on your own conclusions
51. A _______________ health care facility is often owned or managed by the county or state government.
52. The three components of the Scope of Practice are Practice Management and Advancement, Practice Resources, and _______________.
Practice Standards
53. Examples of _______________ include the National Guideline Clearinghouse and the Evidence Analysis Library.
Practice Resources
54. A health professional who requires a four-year post-bachelor’s degree, an internship and residency, and licensing to practice is a_______________.
55. A licensed health professional who compounds and dispenses medications is called a(n) _______________.
56. Currently, the system of health care in the United States is structured around _______________.
health insurance
57. The _______________ extends the availability of health insurance to all Americans.
Affordable Care Act (ACA); ACA; Affordable Care Act
58. Individual state _______________ programs are expanding to serve lower-income Americans.
Medicaid
59. Under the _______________, children 3–18 years old and their families will be able to see an RD for nutrition counseling.
Alliance Healthcare Initiative
60. Nutritional care requires _______________ among members of the entire health care team.
collaboration
61. Examples of _______________ include Scope of Practice Decision Tool and Medical Nutrition Therapy Tools.
Management and Advancement
62. The path to becoming an RD requires both _______________ and _______________.
education; practice
practice; education
63. The dietitian must reflect on her or his practice in order to anticipate and react appropriately to _______________.
change
64. Under the _______________, RDNs can obtain provider numbers that allow for reimbursement of services.
group contract
65. Dietetics practice should not be based on tradition but on _______________ research.
evidence-based
66. Dietitians continually use the process of _______________ to determine the nutrition diagnosis and monitor a patient's progress and/or response to nutrition therapy.
67. National Cancer Institute defined _______________ therapy as treatment based on nutrition.
medical nutrition
68. _______________ is the act of thinking using the mind to organize and integrate information, make inferences, identify relationships, form conclusions, and make decisions.
Critical thinking
69. The dietitian's _______________ base is continually changing and expanding.
knowledge
70. Attitudes reflect the dietitian's values and should ensure that clinical judgment is made _______________ and _______________.
fairly; responsibly
responsibly; fairly
71. List the three different categories of the dietetics Scope of Practice, and give an example of each.
The first area of the Scope of Practice is Practice Standards and an example is the Code of Ethics. Practice Management and Advancement is the second category and an example is the Scope of Practice Decision Tool. Practice Resources is the third component and an example is the National Guideline Clearinghouse.
72. Describe the major tasks of the clinical dietitian.
The clinical dietitian is responsible for nutritional screening and assessment of patients to determine the presence or risks of developing a nutrition-related problem. The clinical dietitian is also involved with development of nutritional diagnosis, nutrition intervention, and monitoring and evaluation of the nutrition care plan.
73. Explain the impact of the Affordable Care Act on nutrition services.
The Affordable Care Act will require more preventative services, such as counseling regarding obesity, weight loss, healthy diet, and exercise. It will also expect more services for educating adults about dietary practices to control hyperlipidemia and other known risk factors for cardiovascular and other chronic, diet-related diseases.Under the Affordable Care Act, nutrition services are expected toexpand.
74. Describe the dietitian's knowledge base as used in clinical practice.
The knowledge base is the dietitian's knowledge about nutrition and its role in health and disease. It includes information and theories related to communications, physical and biological sciences, research, food science, nutrition, management, informatics, and governance of dietetics practice.
75. List the components of critical thinking.
The components of critical thinking include specific knowledge base, experience, medical problem solving, evidence-based dietetics practice, problem solving, diagnostic reasoning, attitudes, and standards.
76. Describe a scenario in which a patient is admitted to a hospital for dehydration and pneumonia. List the members of the interdisciplinary health care team and describe the potential roles of each member in this patient's care.
In the health care setting, individuals from different disciplines communicate with each other regularly in order to best care for their patients. Dietitians are integral members of the patient's health care team and collaborate with physicians, pharmacists, nurses, speech pathologists, occupational therapists, social workers, and many others when providing nutritional treatment. Dietitians must know the roles of the other team members in order to be effective and to ensure optimal patient care.
77. Explain the importance of experience on critical-thinking skills in clinical practice.
The component of critical thinking evolves from experience within dietetic practice. Dietitians do not learn from textbooks alone; they also learn by observing, listening to patients, interacting with other health care professionals, reading patients' medical charts, and reflecting on the situations that arise.
78. Describe a situation in which a dietitian would use evidence-based practice to update a facility's policy regarding total parenteral nutrition.
Changes in nutrition therapy recommendations are inevitable because of new developments in science and medicine, including ongoing research in nutrition therapy. A dietitian must be able to critically review research findings by utilizing the research methodology skills learned during dietetics education. Dietetics practice should not be based on tradition but on evidenced-based research. A search of the medical literature reveals research articles that may support change that could be implemented into facility policy.
79. Use the decision-making process to describe an example of making a decision for a patient who needs dietary changes because of celiac disease.
The activities involved in decision making include identifying and defining a problem or situation, assessing all options for solving the problem, weighing each option against a set of criteria, testing possible options, considering the consequences of the decision, and making a final decision.
80. Describe a situation in which a patient is hospitalized because of malnutrition and swallowing disorder. List the members of the interdisciplinary health care team and describe the potential roles of each member in taking care of the patient.
In the health care setting, individuals from different disciplines communicate with each other regularly in order to best care for their patients. Dietitians are integral members of the patient's health care team and collaborate with speech pathologists, occupational therapists, pharmacists, and many others when providing nutritional treatment. Speech-language pathologists assess, treat, and help to prevent swallowing disorder. Occupational therapists work with the patient to provide special instructions on eating and the use of adaptive feeding devices.
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