ACBN Case Studies & Practical Application 2 — Questions and Answers
Question 1: A 55-year-old male with type 2 diabetes and hypertension reports fasting blood glucose of 180 mg/dL and BP of 145/92 mmHg. Which dietary modification should be prioritized first?
- Eliminate all dietary fat
- Reduce sodium to <2,300 mg/day and refined carbohydrates simultaneously (Correct answer)
- Increase protein to 40% of total calories
- Supplement with magnesium only
Correct answer: Reduce sodium to <2,300 mg/day and refined carbohydrates simultaneously
Addressing both sodium reduction and refined carbohydrate restriction simultaneously targets both hypertension and glycemic control, the two primary concerns.
Question 2: A breastfeeding mother asks about her increased nutrient needs. Which nutrient has the highest percentage increase above baseline DRI during lactation?
- Calcium
- Iron
- Iodine (Correct answer)
- Vitamin D
Correct answer: Iodine
Iodine requirements increase by approximately 90 mcg/day during lactation, representing the largest percentage increase above baseline DRI.
Question 3: A client with celiac disease presents with persistent fatigue and lab results showing low ferritin, low folate, and low vitamin D. What is the most likely explanation?
- Poor dietary compliance alone
- Small intestinal damage causing malabsorption of multiple nutrients (Correct answer)
- Increased urinary excretion of micronutrients
- Competition between celiac antibodies and nutrient receptors
Correct answer: Small intestinal damage causing malabsorption of multiple nutrients
Celiac disease causes villous atrophy in the small intestine, impairing absorption of iron, folate, vitamin D, and many other nutrients even with dietary compliance.
Question 4: A 70-year-old woman with osteoporosis is prescribed bisphosphonate therapy. What nutritional counseling is most critical regarding calcium supplementation timing?
- Take calcium supplements with the bisphosphonate for better absorption
- Separate calcium supplements by at least 30 minutes from bisphosphonate administration (Correct answer)
- Avoid all calcium supplementation while on bisphosphonates
- Take calcium only at bedtime to avoid drug interaction
Correct answer: Separate calcium supplements by at least 30 minutes from bisphosphonate administration
Calcium significantly impairs bisphosphonate absorption; supplements must be separated by at least 30 minutes (and ideally 2 hours) from medication intake.
Question 5: A collegiate wrestler is cutting 8 lbs in 5 days before a weigh-in using severe fluid and food restriction. Which acute risk should the nutritionist emphasize most urgently?
- Long-term bone density loss
- Cardiac arrhythmia from electrolyte imbalance (Correct answer)
- Decreased testosterone levels
- Vitamin C deficiency
Correct answer: Cardiac arrhythmia from electrolyte imbalance
Rapid dehydration and electrolyte depletion—particularly potassium and sodium—can trigger life-threatening cardiac arrhythmias in the short term.
Question 6: A 28-year-old vegan woman in her first trimester of pregnancy has a serum B12 of 180 pg/mL (normal >200). What is the most appropriate intervention?
- Advise her to eat fortified foods and recheck in 6 months
- Recommend immediate B12 supplementation of at least 2.4 mcg/day (preferably higher) (Correct answer)
- Suggest she add fish to her diet only
- No intervention needed since the value is close to normal
Correct answer: Recommend immediate B12 supplementation of at least 2.4 mcg/day (preferably higher)
Low B12 during pregnancy risks fetal neural tube defects and neurological damage; supplementation above the baseline DRI is warranted immediately.
Question 7: A patient post-Roux-en-Y gastric bypass surgery reports tingling in hands and feet 18 months post-op. Labs show normal glucose but low copper. What dietary or supplement recommendation is most appropriate?
- High-dose zinc supplementation
- Copper supplementation and review zinc-to-copper ratio in current supplement regimen (Correct answer)
- Increased red meat intake only
- B12 injection therapy
Correct answer: Copper supplementation and review zinc-to-copper ratio in current supplement regimen
Post-bypass copper deficiency causes peripheral neuropathy; excess zinc supplementation (common post-surgery) competitively inhibits copper absorption and should be evaluated.
ACBN Case Studies & Practical Application 2
A 55-year-old male with type 2 diabetes and hypertension reports fasting blood glucose of 180 mg/dL and BP of 145/92 mmHg.
Which dietary modification should be prioritized first?