ACBN ACBN Clinical Nutrition & Medical Nutrition Therapy 2 — Questions and Answers
Question 1: Which indirect calorimetry measurement is considered the gold standard for determining resting energy expenditure (REE) in clinical settings?
- Metabolic cart (respiratory gas analysis) (Correct answer)
- Harris-Benedict equation
- Mifflin-St Jeor equation
- Penn State equation
Correct answer: Metabolic cart (respiratory gas analysis)
Metabolic cart calorimetry measures actual oxygen consumption and CO2 production to calculate REE, and is far more accurate than predictive equations.
Question 2: In MNT for celiac disease, which protein must be eliminated from the diet?
- Gluten (gliadin and glutenin) (Correct answer)
- Casein
- Whey protein
- Albumin
Correct answer: Gluten (gliadin and glutenin)
Gluten, composed of gliadin and glutenin found in wheat, barley, and rye, triggers the autoimmune intestinal damage characteristic of celiac disease.
Question 3: A patient with a nasogastric tube feeding who develops diarrhea should first be evaluated for:
- Formula osmolality, rate, temperature, and medication side effects (Correct answer)
- Protein deficiency
- Caloric overfeeding
- Vitamin deficiency
Correct answer: Formula osmolality, rate, temperature, and medication side effects
Enteral feeding-related diarrhea is commonly caused by hyperosmolar formulas, rapid infusion rates, cold formula, or concurrent antibiotic/sorbitol-containing medications.
Question 4: The nutrition-focused physical exam (NFPE) assesses which of the following to diagnose malnutrition?
- Muscle and fat loss, fluid accumulation, and grip strength (Correct answer)
- Blood pressure and heart rate
- Skin turgor only
- Body mass index alone
Correct answer: Muscle and fat loss, fluid accumulation, and grip strength
NFPE evaluates muscle wasting (temples, clavicles, scapulae), subcutaneous fat loss, edema, and functional measures like handgrip strength to characterize malnutrition.
Question 5: For patients receiving total parenteral nutrition (TPN), which electrolyte is added to prevent Wernicke's encephalopathy?
- Thiamine (vitamin B1) (Correct answer)
- Folate
- Vitamin B12
- Zinc
Correct answer: Thiamine (vitamin B1)
Thiamine must be added to TPN or given IV before initiating TPN with dextrose to prevent Wernicke's encephalopathy in malnourished or alcoholic patients.
Question 6: In managing phenylketonuria (PKU), the primary dietary treatment involves:
- Restricting phenylalanine intake while supplementing tyrosine (Correct answer)
- Eliminating all protein
- Low-fat diet
- Restricting carbohydrates
Correct answer: Restricting phenylalanine intake while supplementing tyrosine
PKU management requires limiting phenylalanine (found in high-protein foods) while supplementing tyrosine, which becomes essential since the conversion enzyme is absent.
ACBN ACBN Clinical Nutrition & Medical Nutrition Therapy 2
Which indirect calorimetry measurement is considered the gold standard for determining resting energy expenditure (REE) in clinical settings?