Nutrition Therapy And Pathophysiology, 3rd Edition Test Bank

True / False 1. Comparing nutrient intake to nutrient requirements alone effectively describes the broad picture of nutritional status. a. True b. False ANSWER: False DIFFICULTY: Bloom’s: Understand REFERENCES: Improving Health and Nutrition Status Through Nutrition Care 2. Providing nutrition care can influence and change the factors that contribute to an imbalance in nutritional status and thus restore nutritional health. a. True b. False ANSWER: True DIFFICULTY: Bloom’s: Understand REFERENCES: Purpose of Providing Nutrition Care 3. Standardized language refers to a uniform terminology that is used to describe practice. a. True b. False ANSWER: True DIFFICULTY: Bloom’s: Remember REFERENCES: The AND‟s Standardized Nutrition Care Process 4. There are three sets of standardized terminology: nutrition diagnosis; nutrition analysis, and nutrition evaluation. a. True b. False ANSWER: False DIFFICULTY: Bloom’s: Remember REFERENCES: The AND‟s Standardized Nutrition Care Process 5. Central to providing nutrition care is the relationship between the client and the dietetics practitioner or team of dietetics practitioners. a. True b. False ANSWER: True DIFFICULTY: Bloom’s: Understand REFERENCES: Big Picture of Nutrition Care: The Model 6. The outermost ring of the nutrition care process model recognizes the strengths that dietetics practitioners bring to the nutrition care process. a. True b. False ANSWER: False DIFFICULTY: Bloom’s: Understand REFERENCES: Big Picture of Nutrition Care: The Model 7. The nutrition diagnosis portion of the NCP model includes planning and documenting interventions. a. True b. False ANSWER: False DIFFICULTY: Bloom’s: Apply REFERENCES: Big Picture of Nutrition Care: The Model 8. Both external (environmental) and internal (resources of the dietetics practitioner) factors influence the type of nutrition care provided. a. True b. False ANSWER: True DIFFICULTY: Bloom’s: Understand REFERENCES: Big Picture of Nutrition Care: The Model 9. A nutrition assessment is a systematic process of obtaining, verifying, and interpreting data in order to make decisions about the nature and cause of nutrition-related problems. a. True b. False ANSWER: True DIFFICULTY: Bloom’s: Understand REFERENCES: Steps of the NCP 10. A nutrition diagnosis is written in terms of a client problem for which nutrition-related activities provide the primary intervention. a. True b. False ANSWER: True DIFFICULTY: Bloom’s: Understand REFERENCES: Steps of the NCP Multiple Choice 11. Attitudes, knowledge, and behaviors that influence an individual‟s food and physical activity choices are called: a. food and nutrient factors. b. lifestyle factors. c. biological factors. d. environmental factors. e. system factors. ANSWER: b DIFFICULTY: Bloom’s: Understand REFERENCES: Improving Health and Nutritional Status Through Nutrition Care 12. Social and cultural food preferences and practices are external influences affecting food consumption and are called: a. food and nutrient factors. b. lifestyle factors. c. biological factors. d. environmental factors. e. system factors. ANSWER: d DIFFICULTY: Bloom’s: Understand REFERENCES: Improving Health and Nutritional Status Through Nutrition Care 13. The purpose of nutritional care is to: a. cure the underlying medical problem or disease. b. restore a state of nutritional balance. c. impact all lifestyle, environmental, and food and nutrient factors. d. increase supplementation. e. maintain a focus on important vitamins and nutrients. ANSWER: b DIFFICULTY: Bloom’s: Understand REFERENCES: Purpose of Providing Nutrition Care 14. Standardized nutrition language consists of: a. concise phrases that are organized into groups. b. broad terms that are categorized into sets. c. a list of words that are available to use in documentation. d. descriptive terms that cannot be used interchangeably. e. a chart that provides terminology to choose for documentation. ANSWER: a DIFFICULTY: Bloom’s: Understand REFERENCES: The AND‟s Standardized Nutrition Care Process 15. There are three sets of standardized terminology: nutrition diagnosis, nutrition assessment, and: a. nutrition monitoring. b. nutrition evaluation. c. nutrition analysis. d. nutrition investigation. e. nutrition intervention. ANSWER: e DIFFICULTY: Bloom’s: Remember REFERENCES: The AND‟s Standardized Nutrition Care Process 16. The NCP combines the process of care with the: a. analysis of research. b. provision of services. c. content of care. d. diagnosis of problems. e. evaluation of care. ANSWER: c DIFFICULTY: Bloom’s: Understand REFERENCES: The AND‟s Standardized Nutrition Care Process 17. Which portion of the nutrition care process requires appropriate data collection? a. Nutrition diagnosis b. Nutrition assessment c. Nutrition collection d. Nutrition intervention e. Nutrition prescription ANSWER: b DIFFICULTY: Bloom’s: Apply REFERENCES: The AND‟s Standardized Nutrition Care Process 18. The nutrition monitoring and evaluation process of the NCP involves: a. finding patterns and relationships among data and possible causes. b. setting and prioritizing goals. c. stating the problem clearly. d. defining the basic plan. e. selecting appropriate indicators or measures. ANSWER: e DIFFICULTY: Bloom’s: Apply REFERENCES: The AND‟s Standardized Nutrition Care Process 19. Which element is included in the outermost ring of the nutrition care process model? a. Health care and social systems b. Practical knowledge c. Professional skills d. Collaboration and communication e. Critical thinking skills ANSWER: a DIFFICULTY: Bloom’s: Understand REFERENCES: Big Picture of Nutrition Care: The Model 20. Which best describes an aspect of the screening and referral system? a. Monitoring the success of the NCP b. Analyzing causes of sub-optimal performance c. Refining the use of the NCP d. Involving interdisciplinary collaboration e. Identifying diagnostic labels using the PES format ANSWER: d DIFFICULTY: Bloom’s: Analyze REFERENCES: Big Picture of Nutrition Care: The Model 21. A(n) ____ identifies those individuals or groups who would benefit from nutrition care provided by dietetics professionals. a. social system b. goal setting system c. screening and referral system d. medical nutrition therapy system e. outcomes management system ANSWER: c DIFFICULTY: Bloom’s: Apply REFERENCES: Big Picture of Nutrition Care: The Model 22. Which best describes an example of the nutrition-focused physical findings domain used in the nutrition assessment process? a. Oral health and appetite b. Educational background c. Family and social history d. Medical treatments and therapies e. Eligibility for community programs ANSWER: a DIFFICULTY: Bloom’s: Understand REFERENCES: Steps of the NCP 23. Socioeconomic factors are an example of which type of domain used in the nutrition assessment process? a. Anthropometric measurements b. Nutrition-focused physical findings c. Client history d. Food and nutrition-related history e. Biochemical data ANSWER: c DIFFICULTY: Bloom’s: Apply REFERENCES: Steps of the NCP 24. Nutrition diagnosis is a direct link between ____ and ____. a. nutrition analysis, nutrition evaluation b. nutrition evidence, nutrition factors c. nutrition assessment, nutrition monitoring d. nutrition analysis, nutrition intervention e. nutrition assessment, nutrition intervention ANSWER: e DIFFICULTY: Bloom’s: Understand REFERENCES: Steps of the NCP 25. Which best describes an example of the behavioral-environmental domain used in the nutrition diagnosis process? a. Intake of unsafe food b. Impaired nutrient utilization c. Unintended weight loss d. Malabsorption of fats e. Low blood glucose levels ANSWER: a DIFFICULTY: Bloom’s: Apply REFERENCES: Steps of the NCP 26. Unintended weight loss is an example of which type of domain used in the nutrition diagnosis process? a. Behavioral b. Environmental c. Intake d. Clinical e. Social ANSWER: d DIFFICULTY: Bloom’s: Apply REFERENCES: Steps of the NCP 27. Which aspect of the PES statement is described as the diagnostic label? a. Etiology b. Problem c. Signs d. Possibility e. Symptoms ANSWER: b DIFFICULTY: Bloom’s: Remember REFERENCES: Steps of the NCP 28. The ____ step of the PES asks the question “why?” a. possibility b. signs c. problem d. etiology e. symptoms ANSWER: d DIFFICULTY: Bloom’s: Understand REFERENCES: Steps of the NCP 29. Which documentation is most appropriate in a case where a nutrition assessment reveals no nutritional problems? a. “No change” b. “No nutrition diagnosis” c. “No assessment completed” d. “Not applicable” e. “No documentation necessary” ANSWER: b DIFFICULTY: Bloom’s: Apply REFERENCES: Steps of the NCP 30. Which question is most appropriate when evaluating the “P” in the PES statement? a. Is the etiology truly the root cause? b. Is there an intervention that will cause a positive change? c. Will measuring symptoms resolve the problem? d. Can the dietetics practitioner improve the issue? e. Do the signs and symptoms describe the problem? ANSWER: d DIFFICULTY: Bloom’s: Analyze REFERENCES: Steps of the NCP 31. Which best describes an example of objective data obtained from the nutrition assessment? a. “Excessive energy intake” b. “Very little appetite” c. “BMI 28.2” d. “Recent weight gain” e. “Decreased activity levels” ANSWER: c DIFFICULTY: Bloom’s: Understand REFERENCES: Steps of the NCP 32. After prioritizing diagnoses and writing a nutrition prescription, what is the next step for the dietetics practitioner? a. Evaluating the response to interventions b. Identifying ideal goals c. Monitoring for changes in outcomes d. Documenting signs and symptoms e. Labeling the problem ANSWER: b DIFFICULTY: Bloom’s: Apply REFERENCES: Steps of the NCP 33. Which best describes ideal goals? a. Problem labels that classify the facts available b. Identification and analysis of scientific data c. Values used to control specific health conditions d. Data used to make choices about problems e. Evaluation of the entire nutrition care process ANSWER: c DIFFICULTY: Bloom’s: Analyze REFERENCES: Steps of the NCP 34. The desired changes to be achieved over time as a result of nutrition intervention are called: a. diagnostic indicators. b. nutrition assessments. c. screening and referral systems. d. expected outcomes. e. outcomes management systems. ANSWER: d DIFFICULTY: Bloom’s: Understand REFERENCES: Steps of the NCP 35. Motivational interviewing is an example of which type of domain used in the nutrition intervention process? a. Nutrition education b. Food and nutrient delivery c. Coordination of nutrition care d. Diagnostic labeling e. Nutrition counseling ANSWER: e DIFFICULTY: Bloom’s: Apply REFERENCES: Steps of the NCP 36. Which best describes an example of the food and nutrient delivery domain used in the nutrition intervention process? a. Modifying the composition of meals b. Referring to community agencies c. Developing skills in dietary preparation d. Consulting with local agencies e. Educating the patient about fat intake ANSWER: a DIFFICULTY: Bloom’s: Apply REFERENCES: Steps of the NCP 37. Which characteristic distinguishes the nutrition diagnosis from any other type of diagnosis? a. It is a diagnosis for which nutrition-related activities provide the primary intervention b. It is written in a specific format c. It is designed to nutritionally cure the underlying disease d. It is a way of measuring positive outcomes e. It involves a care process that leads to formulating the diagnosis ANSWER: a DIFFICULTY: Bloom’s: Analyze REFERENCES: Steps of the NCP 38. Dietetics practitioners can best arrange problems in order of importance for the client by: a. performing interventions. b. reviewing the goals for the client. c. ranking the diagnoses. d. communicating ideal outcomes to others. e. modifying the NCP on a regular basis. ANSWER: c DIFFICULTY: Bloom’s: Apply REFERENCES: Steps of the NCP 39. The recommended dietary intake of nutrients based on the nutrition diagnosis and the client‟s current health condition is called the: a. nutrition assessment. b. health and referral system. c. nutrition monitoring system. d. outcomes evaluation. e. nutrition prescription. ANSWER: e DIFFICULTY: Bloom’s: Apply REFERENCES: Steps of the NCP 40. The action phase of the nutrition care process is: a. implementation. b. estimation. c. planning. d. assessment. e. diagnosis. ANSWER: a DIFFICULTY: Bloom’s: Apply REFERENCES: Steps of the NCP 41. Determining that the goals and outcomes anticipated by the client and the dietitian are being achieved is best completed by: a. planning. b. monitoring. c. diagnosing. d. assessing. e. intervening. ANSWER: b DIFFICULTY: Bloom’s: Apply REFERENCES: Steps of the NCP 42. Which best explains the key to measuring outcomes? a. Creating a chart for organization b. Modifying the data to simplify it c. Ranking the diagnoses available d. Knowing what needs to be measured e. Reviewing the goals prior to measurement ANSWER: d DIFFICULTY: Bloom’s: Understand REFERENCES: Steps of the NCP 43. The NCP provides clear examples of the types of outcomes to be measured. These include clinical and health status outcomes such as: a. blood pressure and sodium levels. b. medication changes. c. offerings for educational opportunities. d. satisfaction and quality of life. e. planned health care visits. ANSWER: a DIFFICULTY: Bloom’s: Apply REFERENCES: Steps of the NCP 44. A dietitian is documenting a patient‟s nutrition outcome status as “possible progress toward goal.” This is best described by which term? a. Resolved b. Improvement shown c. Unresolved d. No longer appropriate e. Not applicable ANSWER: b DIFFICULTY: Bloom’s: Apply REFERENCES: Steps of the NCP 45. The “P” in the SOAP format of documentation stands for: a. prescription. b. problem. c. progress. d. plan. e. performance. ANSWER: d DIFFICULTY: Bloom’s: Apply REFERENCES: Documentation Case Study Multiple Choice Ms. S is a 40-year-old female admitted to the hospital with nausea and vomiting. She had a Roux en Y gastric bypass two months ago. She reports that her symptoms have been persistent for two weeks and she cannot keep any food down, not even Gatorade. She reports not taking any vitamin and mineral supplements recommended by the RD because “they taste bad.” HT: 5‟4” WT: 200# Diet: NPO 46. Identifying Ms. S‟s current height and weight is an example from which domain of the nutrition assessment terminology? a. Food and nutrition related history b. Nutrition-focused physical findings c. Anthropometric measurements d. Medical tests and procedures e. Client history ANSWER: c DIFFICULTY: Bloom’s: Apply REFERENCES: Steps of the NCP PREFACE NAME: Ms.S 47. Ms. S‟s nausea and vomiting are examples from which domain of the nutrition diagnosis process? a. Behavioral b. Clinical c. Environmental d. Biochemical e. Medical tests and procedures ANSWER: b DIFFICULTY: Bloom’s: Apply REFERENCES: Steps of the NCP PREFACE NAME: Ms.S 48. The dietitian writes a PES statement for Ms. S‟s condition. Which best describes an example of the etiology for this patient? a. Symptoms lasting two weeks b. Inadequate dietary intake c. Roux en Y procedure two months ago d. Potential for electrolyte imbalance e. Decreased vitamin intake ANSWER: c DIFFICULTY: Bloom’s: Analyze REFERENCES: Steps of the NCP PREFACE NAME: Ms.S 49. Based on Ms. S‟s nutrition profile, the dietitian contacts the physician for recommendations for parenteral feedings. This action is an example of which domain of the nutrition intervention process? a. Coordination of nutrition care b. Food and nutrient delivery c. Nutrition education d. Anthropometric measurements e. Nutrition counseling ANSWER: a DIFFICULTY: Bloom’s: Analyze REFERENCES: Steps of the NCP PREFACE NAME: Ms.S 50. The dietitian is documenting Ms. S‟s information using the ADIME method of charting. According to this format, which information is documented under the “A” section? a. “Potential for inadequate fluid intake” b. “Addition of vitamins to IV fluids” c. “Nutrition prescription provided for parenteral feedings” d. “Risk of electrolyte imbalance” e. “Nausea and vomiting for two weeks” ANSWER: e DIFFICULTY: Bloom’s: Analyze REFERENCES: Documentation PREFACE NAME: Ms.S Completion 51. Dietitians are uniquely qualified to provide nutrition care to persons in different states of _______________ to improve their nutritional status. ANSWER: health DIFFICULTY: Bloom’s: Understand REFERENCES: Improving Health and Nutrition Status Through Nutrition Care 52. _______________ factors such as social and cultural food preferences and practices are external influences that impact both food consumption and lifestyle choices. ANSWER: Environmental DIFFICULTY: Bloom’s: Understand REFERENCES: Improving Health and Nutrition Status Through Nutrition Care 53. The Institute of Medicine defines quality as “the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current _______________.” ANSWER: professional knowledge, knowledge DIFFICULTY: Bloom’s: Remember REFERENCES: The AND‟s Standardized Nutrition Care Process 54. The outermost ring of the model identifies _______________ that can have an impact on the ability of the client to receive and benefit from the interventions of nutrition care. ANSWER: environmental factors DIFFICULTY: Bloom’s: Remember REFERENCES: Big Picture of Nutrition Care: The Model 55. The steps of the nutrition care process are supported by two other systems: the _______________ system and the _______________ system. ANSWER: screening and referral; outcomes management, outcomes management; screening and referral DIFFICULTY: Bloom’s: Understand REFERENCES: Big Picture of Nutrition Care: The Model 56. The inner adjoining ring of the nutrition care model recognizes the _______________ that dietetics practitioners bring to the nutrition care process. ANSWER: strengths DIFFICULTY: Bloom’s: Understand REFERENCES: Big Picture of Nutrition Care: The Model 57. The type of data collected during a nutrition assessment depends on whether a(n) _______________ or a(n) _______________ is being conducted. ANSWER: initial assessment; reassessment, reassessment; initial assessment DIFFICULTY: Bloom’s: Understand REFERENCES: Steps of the NCP 58. Nutrition diagnosis is the direct link between nutrition _______________ and nutrition _______________. ANSWER: assessment; intervention, intervention; assessment DIFFICULTY: Bloom’s: Remember REFERENCES: Steps of the NCP 59. The _______________ (S) are the defining characteristics obtained from the subjective and objective nutrition assessment data in the PES statement. ANSWER: signs and symptoms, symptoms and signs DIFFICULTY: Bloom’s: Remember REFERENCES: Steps of the NCP 60. _______________ is a critical component of the NCP that requires collecting data over time. ANSWER: Measuring outcomes DIFFICULTY: Bloom’s: Understand REFERENCES: Steps of the NCP 61. _______________ are the desired changes to be achieved over time as a result of nutrition intervention. ANSWER: Expected outcomes DIFFICULTY: Bloom’s: Understand REFERENCES: Steps of the NCP 62. The final step of planning the nutrition intervention is the _______________ of the appropriate. intervention. ANSWER: selection DIFFICULTY: Bloom’s: Apply REFERENCES: Steps of the NCP 63. Evidence-based guidelines link external _______________ regarding nutrition care to a(n) _______________. ANSWER: scientific evidence; specific health problem DIFFICULTY: Bloom’s: Apply REFERENCES: Steps of the NCP 64. First and foremost is the need to prioritize the _______________, before writing a nutrition prescription. ANSWER: nutrition diagnoses, diagnoses DIFFICULTY: Bloom’s: Understand REFERENCES: Steps of the NCP 65. Interventions are derived from accurate diagnoses and largely driven by _______________. ANSWER: client involvement, patient involvement DIFFICULTY: Bloom’s: Remember REFERENCES: Steps of the NCP 66. The standardized terms from monitoring and evaluation are combined with nutrition _______________ terms. ANSWER: assessment DIFFICULTY: Bloom’s: Understand REFERENCES: Steps of the NCP 67. Evaluating outcomes requires comparing the current _______________ with the previous _______________. ANSWER: findings; signs and symptoms, findings; symptoms and signs DIFFICULTY: Bloom’s: Apply REFERENCES: Steps of the NCP 68. The standardized language that is now part of the NCP improves both the _______________ and _______________ communication among members of the health care team, as well as communication with the patient. ANSWER: written; oral, oral; written DIFFICULTY: Bloom’s: Understand REFERENCES: Documentation 69. Documentation should be relevant, accurate, and _______________. ANSWER: timely DIFFICULTY: Bloom’s: Understand REFERENCES: Documentation 70. A form of charting based on the steps of the NCP, the ADIME stands for assessment, diagnosis, intervention, monitoring and _______________. ANSWER: evaluation DIFFICULTY: Bloom’s: Understand REFERENCES: Documentation Subjective Short Answer 71. List the different factors that impact a person‟s nutritional status and give an example of each. ANSWER: The factors that impact a person‟s nutritional status include human biological, lifestyle, food and nutrient, environmental, and system factors. Biological factors include age or illness; lifestyle factors are attitudes and behaviors; food and nutrient factors include dietary intake; environmental factors include cultural preferences; and systems factors are health or educational systems. DIFFICULTY: Bloom’s: Apply REFERENCES: Improving Health and Nutrition Status Through Nutrition Care 72. Describe each of the components of the nutrition care process model, including the outermost ring, the inner adjoining ring, and the central core. ANSWER: The central core of the nutrition care process model is the relationship between the patient and the dietetics professional. The outer ring identifies environmental factors that can have an impact on the ability of the client to receive and benefit from the interventions of nutrition care. The inner adjoining ring recognizes the strengths that dietetics practitioners bring to the nutrition care process. DIFFICULTY: Bloom’s: Apply REFERENCES: Big Picture of Nutrition Care:The Model 73. Describe the screening and referral system in nutrition care. ANSWER: A screening and referral system identifies those individuals who would benefit from nutrition care provided by dietetics practitioners. They should evaluate how effectively the screening process identifies the clients who require nutrition care. Screening parameters need to be tailored to the population and to the nutrition care services provided and a referral process may also ensure that clients are reliably connected with dietetics practitioners. DIFFICULTY: Bloom’s: Analyze REFERENCES: Big Picture of Nutrition Care:The Model 74. List the three domains of nutrition diagnostic terms and give an example of each. ANSWER: Nutrition diagnostic terms are grouped into three domains: intake, clinical, and behavioralenvironmental. Examples from the intake domain include inadequate oral intake or suboptimal fiber intake. Examples from the clinical domain include swallowing difficulties or unintended weight loss, Examples from the behavioral-environmental domain include feeding difficulties of intake of unsafe food. DIFFICULTY: Bloom’s: Apply REFERENCES: Steps of the NCP Essay 75. List the major tasks associated with the nutrition assessment portion of the nutrition care process. ANSWER: The nutrition assessment involves obtaining and verifying appropriate data, clustering and organizing assessment data according to assessment domains and possible nutrition diagnoses, evaluating the data using reliable standards, and calculating estimated nutrient needs. DIFFICULTY: Bloom’s: Apply REFERENCES: Steps of the NCP 76. Describe, in detail, the benefits of the nutrition care process in terms of outcomes management. Be sure to include benefits relating to the profession as a whole as well. ANSWER: An outcomes management system is used to evaluate the effectiveness and efficiency of the entire NCP (assessment, diagnosis, interventions, outcomes, costs, and other factors) when nutrition care is provided to a number of patients. DIFFICULTY: Bloom’s: Analyze REFERENCES: Big Picture of Nutrition Care:The Model 77. Describe how the dietitian‟s knowledge, skills, and evidence-based practice impact all aspects of the nutrition care process. ANSWER: The strengths that dietetics practitioners bring to the nutrition care process include professional knowledge/skills and competencies, code of ethics, evidence-based practice, and skills of critical thinking, collaboration, and communication. These are the knowledge and skills that registered dietitians and dietetic technicians obtain through accredited didactic and supervised practice programs. DIFFICULTY: Bloom’s: Analyze REFERENCES: Big Picture of Nutrition Care:The Model 78. Give an example scenario of a patient who would require nutrition services while in the hospital. Conceptually, go through the 4 NCP steps and describe the information obtained in each step. In addition, provide a nutrition diagnosis for this patient with the PES components. ANSWER: The NCP consists of four distinct, but interrelated and connected steps: nutrition assessment, nutrition diagnosis,nutrition intervention, and nutrition monitoring and evaluation. Nutrition diagnoses are written in a PES (problem, etiology, signs/symptoms) format that lists the problem, its cause, and appropriate defining characteristics. Examples will vary. DIFFICULTY: Bloom’s: Analyze REFERENCES: Steps of the NCP 79. Describe the differences between using specific diets („renal‟ diet vs. „diabetic‟ diet, for example) and assessment of individual nutrition status. ANSWER: Instead of providing nutrition care/education as a result of a diet order for a diabetic or renal diet, the dietitian should carefully assess the nutritional status of each patient to specifically identify what, if any, nutrition problems (diagnoses) exist. DIFFICULTY: Bloom’s: Analyze REFERENCES: Steps of the NCP 80. Explain the four different domains of the nutrition intervention standardized language. Describe an example of using each domain for a patient who was recently diagnosed with gastroparesis and requires enteral feedings. ANSWER: Like the standardized terms used for nutrition assessment and nutrition diagnosis, intervention terminology is organized into domains: food and/or nutrient delivery, nutrition education, nutrition counseling, and coordination of nutrition care. DIFFICULTY: Bloom’s: Apply REFERENCES: Steps of the NCP