ACBN Risk Assessment & Management 3 — Questions and Answers
Question 1: A nutritionist discovers a client has been self-supplementing with 10,000 IU vitamin D daily for 18 months. Which lab value is most critical to assess for toxicity risk?
- 25-hydroxyvitamin D and serum calcium (Correct answer)
- PTH only
- 1,25-dihydroxyvitamin D only
- Urinary calcium only
Correct answer: 25-hydroxyvitamin D and serum calcium
Vitamin D toxicity manifests as hypercalcemia; measuring 25(OH)D confirms excess storage and serum calcium identifies the primary toxicity endpoint.
Question 2: Which food safety temperature range is known as the 'danger zone' for bacterial growth?
- 20°F to 100°F (-7°C to 38°C)
- 40°F to 140°F (4°C to 60°C) (Correct answer)
- 50°F to 120°F (10°C to 49°C)
- 32°F to 165°F (0°C to 74°C)
Correct answer: 40°F to 140°F (4°C to 60°C)
The USDA defines 40°F–140°F as the temperature danger zone where pathogens multiply most rapidly in food.
Question 3: A client with phenylketonuria (PKU) must restrict which amino acid to prevent neurological damage?
- Tyrosine
- Phenylalanine (Correct answer)
- Leucine
- Tryptophan
Correct answer: Phenylalanine
PKU is caused by deficient phenylalanine hydroxylase; phenylalanine accumulates and is neurotoxic, requiring strict dietary restriction.
Question 4: When conducting a diet history for cardiovascular risk, which dietary factor has the strongest evidence for raising LDL cholesterol?
- Dietary cholesterol from eggs
- Trans fatty acids and saturated fatty acids (Correct answer)
- Omega-6 polyunsaturated fats
- Refined carbohydrates
Correct answer: Trans fatty acids and saturated fatty acids
Trans fatty acids simultaneously raise LDL and lower HDL, while saturated fatty acids raise LDL; both are the most evidence-based dietary LDL-raising factors.
Question 5: Which condition increases the risk of refeeding syndrome when initiating nutritional support?
- Obesity with stable weight
- Prolonged starvation or severe malnutrition (Correct answer)
- Mild dehydration
- Vitamin C deficiency
Correct answer: Prolonged starvation or severe malnutrition
Refeeding syndrome occurs when carbohydrate reintroduction in severely malnourished individuals causes intracellular phosphate shifts, leading to dangerous hypophosphatemia.
Question 6: A pregnant client asks about fish consumption. Which fish poses the highest methylmercury risk and should be avoided entirely?
- Salmon
- Tilefish (Gulf of Mexico) (Correct answer)
- Sardines
- Tilapia
Correct answer: Tilefish (Gulf of Mexico)
Tilefish from the Gulf of Mexico has among the highest methylmercury concentrations of any commercial fish and is on the FDA/EPA 'avoid' list for pregnant women.
Question 7: Which assessment finding most strongly indicates high malnutrition risk in an older adult living independently?
- BMI of 24
- Unintentional 10% weight loss over 6 months (Correct answer)
- Total cholesterol of 190 mg/dL
- Mild fatigue after exercise
Correct answer: Unintentional 10% weight loss over 6 months
Unintentional weight loss of ≥5% over 1 month or ≥10% over 6 months is a major red flag for clinically significant malnutrition in older adults.
ACBN Risk Assessment & Management 3
A nutritionist discovers a client has been self-supplementing with 10,000 IU vitamin D daily for 18 months.
Which lab value is most critical to assess for toxicity risk?