ACBN Risk Assessment & Management 5 — Questions and Answers
Question 1: A client with celiac disease who has been 'gluten-free' for 2 years still has symptoms and low bone density. Which hidden gluten source is most commonly overlooked?
- Fresh fruits and vegetables
- Medications, supplements, and communion wafers (Correct answer)
- Plain rice and potatoes
- Fresh unprocessed meats
Correct answer: Medications, supplements, and communion wafers
Medications and supplements may use wheat starch as excipients, and communion wafers traditionally contain gluten—sources patients frequently fail to report.
Question 2: Which dietary assessment method is most appropriate for estimating population-level nutrient intake in epidemiological studies?
- 3-day weighed food record
- Food frequency questionnaire (FFQ) (Correct answer)
- 24-hour dietary recall (single)
- Diet history interview
Correct answer: Food frequency questionnaire (FFQ)
FFQs capture habitual dietary patterns over months to years at low cost, making them ideal for large epidemiological studies despite lower precision than records.
Question 3: A client with non-alcoholic fatty liver disease (NAFLD) is at greatest risk for progression to cirrhosis if which condition is also present?
- Mild vitamin D insufficiency
- Type 2 diabetes and metabolic syndrome (Correct answer)
- Elevated HDL cholesterol
- Moderate regular alcohol consumption
Correct answer: Type 2 diabetes and metabolic syndrome
Type 2 diabetes and metabolic syndrome amplify hepatic inflammation and fibrosis risk in NAFLD, and their coexistence is the strongest predictor of NASH progression to cirrhosis.
Question 4: Which approach is most effective for managing the nutritional risk of a food-insecure client with hypertension?
- Prescribing the strictest DASH diet protocol
- Connecting client to SNAP and food bank resources while adapting the DASH principles to available foods (Correct answer)
- Recommending expensive specialty foods high in potassium
- Advising the client to reduce food intake to lower caloric load
Correct answer: Connecting client to SNAP and food bank resources while adapting the DASH principles to available foods
Effective risk management integrates social determinants of health; connecting clients to food assistance programs and adapting evidence-based dietary guidance to realistic resources maximizes adherence and outcomes.
Question 5: During a nutrition assessment, a client reports consuming more than 3 alcoholic drinks per day. Which micronutrient deficiency is of highest priority concern?
- Vitamin C
- Thiamine (B1) (Correct answer)
- Vitamin K
- Calcium
Correct answer: Thiamine (B1)
Chronic alcohol use impairs thiamine absorption, increases thiamine excretion, and depletes hepatic stores, placing clients at high risk for Wernicke-Korsakoff syndrome.
Question 6: A client on a very low calorie diet (<800 kcal/day) for weight loss is at increased risk for which cardiac complication?
- Atrial fibrillation from sodium excess
- Ventricular arrhythmia from electrolyte imbalances and protein-energy malnutrition (Correct answer)
- Hypertensive crisis from potassium excess
- Pericarditis from vitamin D deficiency
Correct answer: Ventricular arrhythmia from electrolyte imbalances and protein-energy malnutrition
Severe caloric restriction can cause potassium, magnesium, and protein depletion, which together impair cardiac muscle function and conduction, increasing arrhythmia risk.
Question 7: When performing a risk assessment for a vegan athlete, which nutrient combination requires the most proactive monitoring?
- Vitamins C and E
- Vitamin B12, iron, zinc, and omega-3 fatty acids (Correct answer)
- Vitamins A and K
- Magnesium and potassium
Correct answer: Vitamin B12, iron, zinc, and omega-3 fatty acids
Strict plant-based diets eliminate B12 (found only in animal foods), provide non-heme iron and zinc with lower bioavailability, and lack EPA/DHA omega-3s, creating a cluster of deficiency risks in high-demand athletes.
ACBN Risk Assessment & Management 5
A client with celiac disease who has been 'gluten-free' for 2 years still has symptoms and low bone density.
Which hidden gluten source is most commonly overlooked?