ACBN Risk Assessment & Management 4 — Questions and Answers
Question 1: A client taking lithium for bipolar disorder asks about dietary changes. Which nutritional factor can precipitate lithium toxicity?
- High protein intake
- Low sodium diet (Correct answer)
- High calcium intake
- Increased vitamin B12
Correct answer: Low sodium diet
Sodium and lithium compete for renal reabsorption; a low-sodium diet causes the kidneys to retain lithium, dramatically increasing serum lithium levels and toxicity risk.
Question 2: Which screening tool is recommended by the Academy of Nutrition and Dietetics for identifying nutrition-related risk in community-dwelling older adults?
- MUST
- Determine/NSI Checklist (Correct answer)
- NRS-2002
- GLIM criteria
Correct answer: Determine/NSI Checklist
The Determine/Nutrition Screening Initiative (NSI) Checklist was developed specifically for community-dwelling older adults to identify nutrition-related warning signs.
Question 3: In nutrition-focused physical examination, which finding most specifically indicates zinc deficiency risk?
- Bilateral ankle edema
- Delayed wound healing and dermatitis (Correct answer)
- Glossitis with magenta tongue
- Petechiae on the skin
Correct answer: Delayed wound healing and dermatitis
Zinc plays a critical role in immune function and tissue repair; delayed wound healing and acrodermatitis enteropathica-type dermatitis are classic zinc deficiency signs.
Question 4: A bariatric surgery patient 12 months post-Roux-en-Y gastric bypass presents with peripheral neuropathy. Which deficiency is the most likely cause?
- Vitamin A
- Thiamine (B1) or Vitamin B12 (Correct answer)
- Vitamin D
- Magnesium
Correct answer: Thiamine (B1) or Vitamin B12
RYGB bypasses the stomach and proximal small intestine, severely impairing intrinsic factor production and B12 absorption, while thiamine deficiency can occur from reduced intake and absorption.
Question 5: Which risk factor combination most significantly increases a client's likelihood of developing osteoporosis?
- High calcium diet and regular weight-bearing exercise
- Postmenopausal status, low calcium intake, and smoking (Correct answer)
- Male sex and BMI of 30
- High vitamin K intake and sedentary lifestyle
Correct answer: Postmenopausal status, low calcium intake, and smoking
Estrogen loss at menopause accelerates bone resorption; combined with inadequate calcium and smoking (which impairs estrogen metabolism and calcium absorption), risk becomes cumulative.
Question 6: When assessing dietary risk for colorectal cancer, which food category has the strongest evidence-based association with increased risk?
- Whole grains
- Processed red meats (e.g., bacon, hot dogs) (Correct answer)
- Cruciferous vegetables
- Legumes
Correct answer: Processed red meats (e.g., bacon, hot dogs)
The WHO/IARC classifies processed meats as Group 1 carcinogens (definite cause) for colorectal cancer, making them the highest-evidence dietary risk factor.
Question 7: A client is referred after labs show serum albumin of 2.8 g/dL. What is the primary limitation of using albumin alone to assess nutrition risk?
- Albumin reflects only fat stores, not protein status
- Albumin is an acute-phase reactant and falls during inflammation regardless of nutrition status (Correct answer)
- Albumin is not affected by liver disease
- Albumin levels take only 24 hours to reflect dietary changes
Correct answer: Albumin is an acute-phase reactant and falls during inflammation regardless of nutrition status
Albumin is a negative acute-phase protein; inflammation, infection, or trauma will lower albumin independent of nutritional intake, making it an unreliable standalone marker.
ACBN Risk Assessment & Management 4
A client taking lithium for bipolar disorder asks about dietary changes.
Which nutritional factor can precipitate lithium toxicity?