Krauses Food and the Nutrition Care Process 13th Edition Mahan Raymond Test Bank
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Mahan: Krause’s Food and the Nutrition Care Process, 13th Edition
Chapter 25: Nutrition and Bone Health
- Which of the following dietary variables is NOT related to low bone mass?
|c.||Inadequate vitamin D|
Bone mass is maintained adequate vitamin D and calcium intake and adequate phosphorus to maintain the serum calcium-to-phosphate ratio. Too much phosphorus in relation to calcium stimulates parathyroid hormone, resulting in loss of bone. Oral doses of potassium bicarbonate postmenopausal women neutralize endogenous acids that may contribute to bone resorption.
REF: pp. 532, 538
- Which of the following bone measurements is more appropriate for individuals from late adolescence to the elderly years?
After peak bone mass is achieved about 30 years of age, bone mineral density is the term used to describe bone throughout the rest of life. Bone mineral content is used to describe the amount of bone accumulated before the end of growth (usually in height). Alkaline phosphatase measured in the blood is a marker of bone formation.
REF: p. 535
- Which of the following are bone-forming cells?
Osteoblasts are the cells responsible for the formation of bone tissue. Osteocytes are formed osteoblasts and are incorporated into the mineralized bone. Osteoclasts are responsible for the resorption or breakdown of bone. Osteocalcin is a matrix protein of bone.
REF: p. 532
- Bone tissue consists of the mineral phase and the organic _____ phase.
The organic matrix or osteoid phase of bone consists mostly of collagen, which provides both the strength and flexibility of the bone. Osteocalcin and osteopontin are two proteins that occur in the osteoid phase. Cartilage is the connective tissue that occurs at the epiphyseal ends of bone.
REF: p. 532
- Which of the following is necessary for the maturation of osteocalcin?
Vitamin K is involved in the posttranslational carboxylation process or maturation of osteocalcin. Vitamin D’s role in bone formation is in regard to the adequate absorption of calcium from the gastrointestinal tract as well as the stimulation of osteoblast activity. Adequate vitamin A intake is necessary for the promotion of bone growth and maintenance. Vitamin E does not have a direct role in bone formation.
REF: p. 540
- Which of the following statements about exercise and bone is TRUE?
|a.||Regular weight-bearing exercise has little influence on BMD.|
|b.||Upper-body strength activities may improve overall BMD.|
|c.||Walking several miles each day has a large impact on hip BMD.|
|d.||Swimming regularly has a large impact on vertebral BMD.|
Use of upper body strength activities has been shown to improve the BMD of the femur. Regular weight-bearing exercise seems to have little influence on BMD of older persons but is beneficial during periods of bone accumulation. Walking and swimming similarly do not provide benefit to bone health in elderly adults.
REF: p. 542
- Which of the following is NOT a risk associated with excessive calcium supplementation?
|c.||Urinary tract stones|
|d.||High blood pressure|
Increased calcium intake has been associated with lowered blood pressure. In susceptible individuals, excessive calcium supplementation may result in urinary tract stones. Excessive calcium supplementation may cause constipation and can interfere with the absorption of other divalent cations.
REF: p. 538
- What does uncoupling of bone remodeling mean?
|a.||Bone formation precedes bone resorption.|
|b.||Bone formation both exceeds and precedes bone resorption.|
|c.||Bone resorption precedes bone formation.|
|d.||Bone resorption both precedes and exceeds bone formation.|
The uncoupling of bone remodeling explains why after peak bone mass is achieved, throughout the rest of the life cycle, bone mass declines. Normal bone remodeling involves first bone resorption and then bone formation. However, when uncoupling occurs, more resorption than formation occurs. This results in bone loss.
REF: p. 534
- Which of the following is NOT a characteristic of hormone-related (type I) osteoporosis?
|a.||Rapid rate of bone loss and therefore of BMD|
|b.||Cessation of ovarian estrogen production|
|c.||Decrease in dietary calcium intake|
|d.||Increased risk of fracture of wrist and vertebrae|
Although decreased dietary calcium intake is a risk factor for osteoporosis, it is not specific to either type of osteoporosis. Type I osteoporosis in women results after menopause when estrogen production ceases. The BMD of women with postmenopausal osteoporosis may fall as low as 25% to 40% of that of age-matched women without osteoporosis. Type I osteoporosis is associated with “crush” fractures of the wrists and lumbar vertebrae.
REF: pp. 536,537
- When is the peak bone mass of a female typically achieved?
|a.||By the end of adolescence|
|b.||By approximately 30 years of age|
|c.||Within the decade preceding menopause|
|d.||After the onset of menopause|
Peak bone mass occurs about 30 years of age. Through adolescence, the opportunity exists to increase bone mineral density promoting calcium intake, maintaining weight-bearing activity, and limiting use of alcohol and cigarettes. Around the age of 40 years, BMD gradually declines. After menopause, the rate of loss averages from 1% to 2% per year.
REF: p. 536
- A chronic elevation of which circulating hormone typically leads to an increase in bone resorption and bone loss?
Vitamin D deficiency is associated with secondary hyperparathyroidism. This results in excessive parathyroid hormone secretion, which then stimulates bone resorption to maintain serum calcium concentrations. Excessive use of thyroid hormone or corticosteroids as medications can also contribute to bone loss. Glucagon has not been associated with risk of osteopenia.
REF: pp. 533,534
- Which of the following drug treatments has NOT been proven effective in preventing excessive bone loss?
Although use of fluoride is effective in dental applications, because of alterations in the size and structure of hydroxyapatite crystals in the bone, the mechanical competence of the bone is impaired. Alendronate, a type of bisphosphonate, alone or in combination with selective estrogen receptor modulators, is effective in protecting against fracture development. Calcitonin blocks the activation of osteoclasts PTH and has been shown to improve BMD.
REF: pp. 539, 543, 544
- Which of the following changes related to nutrition and bone metabolism does NOT occur in elderly subjects?
|a.||Decreased intake of protein|
|b.||Reduction of skin biosynthesis of vitamin D|
|c.||Increased renal excretion of calcium|
|d.||Decline in osteoblast function|
Although an excessive sodium intake may contribute to an increased renal excretion of calcium, aging itself does not result in this physiologic change. Aging is associated with decreased intestinal absorption of calcium through alterations in the gastrointestinal mucosa and in vitamin D biosynthesis and metabolism. In contrast to osteoblast activity, osteoclast activity increases because of the uncoupling of bone remodeling.
REF: pp. 536, 537, 539
- The WHO’s definition of osteoporosis is a BMD greater than _____ standard deviations below the mean for healthy 20- to 29-year-old adults.
Compared with the mean BMD of 20- to 29-year-old adults, the World Health Organization defines osteoporosis as a BMD greater than 2.5 standard deviations below the standard.
REF: p. 541
- Which of these is NOT a risk factor for developing osteoporosis?
|b.||European or Asian ethnicity|
|d.||Female athlete triad|
People of European and Asian ethnicity experience more osteoporotic fractures than blacks or Hispanics, who usually have a greater bone density. Cigarette smoking is a risk factor, probably because of toxic effects on bone. Young women with the female athlete triad of disordered eating, amenorrhea, and low BMD are at increased risk of having fractures.
REF: p. 543
- Which of the following female patients is at risk for osteoporosis?
|a.||An African American woman who was normal age at menopause and has a large frame and poor intake of calcium|
|b.||A white woman who is overweight, had multiple pregnancies and late menopause, and consumes alcohol|
|c.||A white woman who is underweight, had premature menopause, does not exercise, and smokes cigarettes|
|d.||An Asian woman who is premenopausal and has a large frame, a high calcium intake, and a sedentary lifestyle|
Risk factors for the development of osteoporosis include being a woman of European or Asian decent, being underweight or sarcopenic, having experienced menopause or oophorectomy, lack of exercise, cigarette smoking, excessive alcohol or caffeine use, and limited intake of calcium and vitamin D.
REF: p. 543
- What is the most beneficial type of exercise to include in an exercise program for a patient at risk for osteoporosis?
Weight-bearing activities place stress on the skeleton and stimulate osteoblast activity during the developmental periods of bone accretion. Swimming, regular walking, and isometrics do not place as much stress on the skeleton and are not associated with improvements in BMD.
REF: p. 542
- Calcium and phosphate ions in a ratio of ________are needed for bone mineralization.
Both calcium and phosphate ions in a ratio of 1:1 are needed for the mineralization of bone. Excessive phosphorus intake as phosphates can greatly alter the calcium-to-phosphate ratio, especially if calcium intake is low.
REF: p. 538
- Which of the following is a characteristic of type II or age-related osteoporosis?
|a.||Occurs after 50 years of age|
|b.||Loss of height occurs|
|c.||Only affects trabecular bone|
|d.||Rarely occurs in males|
Type II osteoporosis, or age-related osteoporosis, usually occurs after 65 years of age and affects both men and women. Type II osteoporosis affects both trabecular and cortical bone. Fractures of the hip and vertebrae are the most common to occur with this type of osteoporosis. Because of the latter, a loss of height, spinal deformity, and dowager’s hump occur.
REF: p. 541
- Which of the following is associated with the bone tissue at the end of the long bones?
Trabecular bone is the spongy bone that is found in the knobends of the long bones. Cortical bone, which consists of osteons or Haversian systems, is found in the shaft regions of the long bones.
REF: p. 532