Commission on Dietetic Registration (CDR) Registration Examination for Dietitian Nutritionists — Questions and Answers

Question 1: How should CDN professionals handle confidential information related to eating disorder treatment?

Store information without any security measures
Delete all records after project completion
Follow established protocols for data protection, access control, and disclosure in accordance with applicable regulations (Correct answer)
Share freely with all colleagues for transparency

Correct answer: Follow established protocols for data protection, access control, and disclosure in accordance with applicable regulations

Confidential information must be handled according to established protocols, regulatory requirements, and professional ethics standards, including proper access control and disclosure procedures.

Question 2: A night eating syndrome (NES) patient reports consuming >25% of daily calories after the evening meal. Which intervention is first-line?

Immediate pharmacotherapy with SSRIs
Sleep restriction therapy only
Structured meal timing with earlier caloric distribution (Correct answer)
Nocturnal tube feeding to redistribute calories

Correct answer: Structured meal timing with earlier caloric distribution

Restructuring meal timing to distribute calories more evenly throughout the day addresses the core behavioral pattern of NES.

Question 3: Which of the following best describes a key competency required for eating disorder treatment in CDN practice?

Reliance on a single methodology for all situations
Strong analytical skills combined with effective communication and ethical judgment (Correct answer)
Memorization of all relevant regulations without understanding context
The ability to work independently without any oversight

Correct answer: Strong analytical skills combined with effective communication and ethical judgment

CDN professionals working in eating disorder treatment need analytical skills to assess situations, communication skills to convey findings, and ethical judgment to make sound decisions.

Question 4: Cyclosporine, an immunosuppressant used after organ transplantation, causes wasting of which electrolyte through nephrotoxic effects on the renal tubules?

Magnesium (Correct answer)
Calcium
Potassium
Phosphorus

Correct answer: Magnesium

Cyclosporine causes renal tubular dysfunction that impairs magnesium reabsorption, leading to hypomagnesemia which can manifest as muscle cramps, tremors, and cardiac arrhythmias.

Question 5: What is the purpose of fiber in digestion?

To regulate digestion and prevent constipation (Correct answer)
To absorb fats
To increase calorie absorption
To slow down digestion

Correct answer: To regulate digestion and prevent constipation

Dietary fiber, though not digestible by human enzymes, adds bulk to stool, which helps to regulate bowel movements and prevent constipation. It facilitates the smooth passage of waste through the digestive tract, contributing to overall gut health and regularity.

Question 6: What role do vitamins play in metabolism?

They store fat
They help enzymes perform metabolic functions (Correct answer)
They only affect mood
They provide energy directly

Correct answer: They help enzymes perform metabolic functions

Vitamins function as coenzymes or cofactors, which are essential for enzymes to catalyze metabolic reactions efficiently. They do not provide energy directly but are critical for processes like energy production, nutrient utilization, and cellular repair.

Question 7: Failure to thrive (FTT) in a 9-month-old is most commonly caused by:

Cystic fibrosis
Milk protein allergy
Inadequate caloric intake (Correct answer)
Congenital hypothyroidism

Correct answer: Inadequate caloric intake

The majority of FTT cases are non-organic and result from inadequate caloric intake due to feeding difficulties, psychosocial issues, or improper formula preparation.

Question 8: A premature infant at 28 weeks gestation requires nutritional support. Which feeding approach is preferred when enteral feeding is tolerated?

Glucose-electrolyte solution
Pasteurized donor human milk fortified with human milk fortifier (Correct answer)
Soy-based formula
Standard cow's milk formula

Correct answer: Pasteurized donor human milk fortified with human milk fortifier

Donor human milk with human milk fortifier is preferred for premature infants to reduce necrotizing enterocolitis risk while meeting higher protein and caloric needs.

Question 9: The thermic effect of food (TEF) contributes approximately what percentage of total daily energy expenditure?

2–3%
15–20%
5–10% (Correct answer)
25–30%

Correct answer: 5–10%

TEF accounts for approximately 5–10% of total daily energy expenditure, representing energy used to digest, absorb, and metabolize nutrients.

Question 10: What is the most effective way to measure success in cultural competency in nutrition within CDN professional practice?

Rely solely on supervisor opinion
Count only the number of activities completed
Use a combination of quantitative metrics, qualitative assessments, and stakeholder feedback aligned with defined objectives (Correct answer)
Compare only with industry averages without considering context

Correct answer: Use a combination of quantitative metrics, qualitative assessments, and stakeholder feedback aligned with defined objectives

Effective measurement combines multiple data sources — quantitative metrics, qualitative assessments, and stakeholder feedback — all aligned with clearly defined objectives for a comprehensive evaluation.

Question 11: In the context of CDN certification, what is the most important consideration when implementing eating disorder treatment?

Delegating all responsibilities to junior staff
Completing implementation as quickly as possible regardless of quality
Minimizing documentation to save time
Ensuring alignment with established standards, stakeholder needs, and best practices (Correct answer)

Correct answer: Ensuring alignment with established standards, stakeholder needs, and best practices

When implementing eating disorder treatment, CDN professionals must ensure alignment with industry standards and stakeholder needs. Hasty implementation without proper planning often leads to compliance issues and suboptimal outcomes.

Question 12: During prolonged fasting, which metabolic state predominates to spare muscle protein?

Glycolysis
Ketosis (Correct answer)
Gluconeogenesis from amino acids only
Lipogenesis

Correct answer: Ketosis

Ketosis allows the brain and other tissues to use ketone bodies as an alternative fuel, reducing the need to catabolize muscle protein for gluconeogenesis.

Question 13: How does inventory management affect food service operations?

It only affects the budget
It ensures necessary items are available and reduces waste (Correct answer)
It has no effect on service
It increases food waste

Correct answer: It ensures necessary items are available and reduces waste

Effective inventory management is crucial for optimizing food service operations by ensuring that all necessary ingredients are on hand to meet demand, while simultaneously minimizing spoilage and waste. This balance helps control costs, maintain food quality, and prevent service disruptions.

Question 14: How does poverty influence community nutrition?

It limits access to healthy foods (Correct answer)
It improves nutrition access
It ensures balanced diets for all
It has no effect on nutrition

Correct answer: It limits access to healthy foods

Poverty significantly impacts community nutrition by creating substantial financial barriers to accessing healthy and nutritious foods. Low-income individuals and families often reside in 'food deserts,' where fresh, affordable produce and healthy options are scarce or prohibitively expensive. This often leads to a reliance on cheaper, less nutritious processed foods, contributing to higher rates of diet-related health issues.

Question 15: Which of the following best describes a key competency required for pediatric & geriatric nutrition in CDN practice?

Reliance on a single methodology for all situations
Strong analytical skills combined with effective communication and ethical judgment (Correct answer)
Memorization of all relevant regulations without understanding context
The ability to work independently without any oversight

Correct answer: Strong analytical skills combined with effective communication and ethical judgment

CDN professionals working in pediatric & geriatric nutrition need analytical skills to assess situations, communication skills to convey findings, and ethical judgment to make sound decisions.

Question 16: What role do vitamins play in metabolism?

They only affect mood
They provide energy directly
They store fat
They help enzymes perform metabolic functions (Correct answer)

Correct answer: They help enzymes perform metabolic functions

Vitamins do not provide energy directly but act as coenzymes or cofactors, assisting enzymes in performing their metabolic functions. They are crucial for facilitating biochemical reactions involved in energy production, nutrient utilization, and overall cellular health. Without adequate vitamins, metabolic processes would be severely impaired.

Question 17: How should CDN professionals handle confidential information related to renal & cardiac nutrition?

Follow established protocols for data protection, access control, and disclosure in accordance with applicable regulations (Correct answer)
Delete all records after project completion
Share freely with all colleagues for transparency
Store information without any security measures

Correct answer: Follow established protocols for data protection, access control, and disclosure in accordance with applicable regulations

Confidential information must be handled according to established protocols, regulatory requirements, and professional ethics standards, including proper access control and disclosure procedures.

Question 18: What is the primary nutritional concern when introducing complementary foods to a 6-month-old breastfed infant?

Protein quantity
Enough vitamin C
Sufficient iron and zinc (Correct answer)
Adequate fat intake

Correct answer: Sufficient iron and zinc

After 6 months, breast milk alone cannot meet iron and zinc demands, making iron-rich complementary foods a priority.

Question 19: What is the standard hang time for an open enteral formula system to prevent microbial contamination?

8 hours (Correct answer)
4 hours
2 hours
12 hours

Correct answer: 8 hours

Open enteral feeding systems should not hang for more than 8 hours to minimize the risk of bacterial contamination and formula degradation.

Question 20: Which nutrient deficiency is a major risk in elderly patients taking long-term proton pump inhibitors (PPIs)?

Vitamin D
Calcium
Vitamin B12 (Correct answer)
Iron

Correct answer: Vitamin B12

PPIs reduce gastric acid secretion needed to cleave B12 from food proteins, impairing absorption and leading to deficiency over time.

Question 21: How should CDN professionals handle confidential information related to cultural competency in nutrition?

Follow established protocols for data protection, access control, and disclosure in accordance with applicable regulations (Correct answer)
Delete all records after project completion
Share freely with all colleagues for transparency
Store information without any security measures

Correct answer: Follow established protocols for data protection, access control, and disclosure in accordance with applicable regulations

Confidential information must be handled according to established protocols, regulatory requirements, and professional ethics standards, including proper access control and disclosure procedures.

Question 22: A client reports emotional eating during stressful periods. Which cognitive-behavioral strategy would be most appropriate?

Recommending a high-protein diet to reduce cravings
Teaching stimulus control by removing trigger foods from the home
Using food journaling to identify emotion-food cue connections (Correct answer)
Prescribing a strict calorie limit

Correct answer: Using food journaling to identify emotion-food cue connections

Food journaling that records emotions alongside eating episodes helps identify triggers and patterns, a foundational CBT technique for emotional eating.

Question 23: Which complication is most associated with rapid advancement of enteral tube feeding in a critically ill patient?

Aspiration pneumonia (Correct answer)
Hypoglycemia
Constipation
Hyponatremia

Correct answer: Aspiration pneumonia

Aspiration pneumonia is a major risk of enteral feeding, particularly with gastric feeds in patients with impaired gastric motility or altered consciousness.

Question 24: What is the role of government policies in community nutrition?

They monitor individual diets
They only focus on food production
They regulate food safety and access to nutrition (Correct answer)
They have no role in nutrition

Correct answer: They regulate food safety and access to nutrition

Government policies play a critical role in shaping the food environment and influencing community nutrition. They establish regulations for food safety, set national dietary guidelines, and implement programs to improve food access for vulnerable populations. These policies can significantly impact food availability, affordability, and quality, thereby directly affecting the nutritional health of a community.

Question 25: Which eating disorder has the highest mortality rate among all psychiatric disorders?

Bulimia nervosa
Avoidant/restrictive food intake disorder
Anorexia nervosa (Correct answer)
Binge eating disorder

Correct answer: Anorexia nervosa

Anorexia nervosa has the highest mortality of any psychiatric disorder, with deaths from cardiac complications and suicide.

Question 26: What role does marketing play in food service management?

It’s only useful for big chains
It’s not important
It helps attract new customers and build brand recognition (Correct answer)
It increases operational costs

Correct answer: It helps attract new customers and build brand recognition

Marketing is essential for food service businesses to effectively communicate their offerings and unique value proposition to potential customers. It helps create brand awareness, differentiate the establishment from competitors, and ultimately drives customer traffic and loyalty. This strategic effort is crucial for attracting new patrons and building a recognizable brand identity, which are vital for business growth and sustainability.

Question 27: Refeeding syndrome in a malnourished patient initiating PN is primarily caused by a shift in which electrolyte?

Calcium
Sodium
Magnesium
Phosphorus (Correct answer)

Correct answer: Phosphorus

Refeeding syndrome is primarily characterized by a rapid intracellular shift of phosphorus, leading to hypophosphatemia as anabolism resumes.

Question 28: Why is customer service important in food service management?

It only influences waitstaff tips
It increases overhead costs
It ensures customer satisfaction and repeat business (Correct answer)
It doesn’t matter in food service

Correct answer: It ensures customer satisfaction and repeat business

Excellent customer service is paramount in food service as it directly influences a customer's overall dining experience and their likelihood of returning. Satisfied customers are more likely to become loyal patrons and recommend the establishment to others, contributing significantly to business success.

Question 29: Which condition is most associated with excess vitamin A intake during pregnancy?

Preterm labor
Teratogenicity and fetal malformations (Correct answer)
Neural tube defects
Gestational diabetes

Correct answer: Teratogenicity and fetal malformations

Preformed vitamin A (retinol) is teratogenic at high doses, causing craniofacial, cardiac, and CNS malformations; pregnant women should avoid supplements exceeding the UL.

Question 30: In motivational interviewing (MI), which technique involves reflecting back what a client has said to encourage deeper exploration?

Affirmation
Open-ended questioning
Reflective listening (Correct answer)
Summarizing

Correct answer: Reflective listening

Reflective listening involves paraphrasing or mirroring the client's statements to demonstrate empathy and promote self-exploration.

Question 31: What is the most effective way to measure success in pediatric & geriatric nutrition within CDN professional practice?

Rely solely on supervisor opinion
Count only the number of activities completed
Compare only with industry averages without considering context
Use a combination of quantitative metrics, qualitative assessments, and stakeholder feedback aligned with defined objectives (Correct answer)

Correct answer: Use a combination of quantitative metrics, qualitative assessments, and stakeholder feedback aligned with defined objectives

Question 32: An 85-year-old with decreased appetite and 10% unintentional weight loss over 6 months meets criteria for which nutritional condition?

Moderate malnutrition
Overweight
Severe malnutrition (Correct answer)
Mild malnutrition

Correct answer: Severe malnutrition

Per ASPEN/AND consensus, unintentional weight loss ≥5% in 1 month or ≥10% in 6 months with reduced intake meets criteria for severe malnutrition in older adults.

Question 33: High-dose aspirin therapy can deplete which vitamin by increasing its renal tubular excretion?

Vitamin E
Vitamin A
Vitamin K
Vitamin C (Correct answer)

Correct answer: Vitamin C

High-dose salicylates compete with vitamin C for renal tubular reabsorption and increase its urinary excretion, potentially contributing to deficiency with chronic use.

Question 34: A breastfed infant whose mother follows a strict vegan diet is at risk for deficiency of which vitamin that requires supplementation?

Vitamin B12 (Correct answer)
Vitamin E
Vitamin C
Vitamin A

Correct answer: Vitamin B12

Vitamin B12 is found almost exclusively in animal products; vegan mothers have low B12 in breast milk, putting infants at risk for neurological damage.

Question 35: An 80-year-old with poor appetite and muscle wasting has low serum albumin (2.8 g/dL). Which condition best explains the low albumin in this context?

Iron-deficiency anemia
Zinc deficiency
Vitamin B12 deficiency
Protein-energy malnutrition (Correct answer)

Correct answer: Protein-energy malnutrition

Protein-energy malnutrition causes decreased hepatic synthesis of albumin, making it a marker of chronic nutritional depletion.

Question 36: When a CDN professional encounters an unfamiliar challenge in weight management counseling, what is the recommended first course of action?

Apply the solution used for the most recent similar problem without adaptation
Research applicable standards, consult with subject matter experts, and document the approach (Correct answer)
Postpone addressing the issue indefinitely
Proceed based on personal intuition alone

Correct answer: Research applicable standards, consult with subject matter experts, and document the approach

Professional practice requires a methodical approach to unfamiliar challenges: research the applicable standards, consult experts when needed, and document the reasoning for the chosen approach.

Question 37: Which access route is preferred for long-term enteral nutrition in a patient with a functional stomach?

Nasojejunal tube
Percutaneous endoscopic gastrostomy (PEG) (Correct answer)
Nasogastric tube
Nasoduodenal tube

Correct answer: Percutaneous endoscopic gastrostomy (PEG)

A PEG tube is preferred for long-term enteral feeding (>4 weeks) in patients with a functional stomach as it is more comfortable and stable.

Question 38: Which vitamin functions as a coenzyme in transamination reactions involving amino acid metabolism?

Thiamine (B1)
Riboflavin (B2)
Niacin (B3)
Pyridoxine (B6) (Correct answer)

Correct answer: Pyridoxine (B6)

Pyridoxal phosphate (PLP), the active form of vitamin B6, is the coenzyme required by aminotransferases (transaminases) that transfer amino groups between molecules.

Question 39: In treating binge eating disorder (BED), which pharmacological agent is FDA-approved and works by reducing binge frequency?

Topiramate
Olanzapine
Sertraline
Lisdexamfetamine (Correct answer)

Correct answer: Lisdexamfetamine

Lisdexamfetamine (Vyvanse) is the only FDA-approved medication specifically indicated for moderate-to-severe BED.

Question 40: Why is sustainability important in food service operations?

It slows down service
It’s not important
It increases operational costs
It reduces environmental impact and builds a positive reputation (Correct answer)

Correct answer: It reduces environmental impact and builds a positive reputation

Sustainability in food service involves adopting practices that minimize environmental harm, such as reducing waste, conserving resources, and sourcing ingredients ethically. These efforts not only lessen the operation's ecological footprint but also enhance its public image and reputation. Consumers increasingly value businesses committed to sustainability, making it a key factor in attracting customers and ensuring long-term business viability.

Question 41: A 14-year-old female athlete presents with amenorrhea, low bone density, and disordered eating. This triad is best described as:

Relative Energy Deficiency in Sport (RED-S)
Female Athlete Triad (Correct answer)
Bulimia nervosa
Anorexia nervosa

Correct answer: Female Athlete Triad

The Female Athlete Triad specifically describes the interrelated conditions of low energy availability, menstrual dysfunction, and low bone mineral density in female athletes.

Question 42: Chronic alcohol abuse impairs the activation of which vitamin primarily through its effects on hepatic hydroxylation?

Vitamin C
Vitamin D (Correct answer)
Vitamin K
Vitamin A

Correct answer: Vitamin D

Alcohol impairs the liver's ability to perform 25-hydroxylation of vitamin D, the first essential step in producing the active hormonal form, leading to metabolic bone disease.

Question 43: At what age does the American Academy of Pediatrics recommend introducing peanut-containing foods to high-risk infants (with severe eczema or egg allergy) to prevent peanut allergy?

12–18 months
2–3 months
9–12 months
4–6 months (Correct answer)

Correct answer: 4–6 months

Based on the LEAP trial, early introduction of peanuts at 4–6 months in high-risk infants significantly reduces the risk of developing peanut allergy.

Question 44: Which lab finding is most indicative of severe malnutrition requiring immediate medical stabilization before outpatient eating disorder treatment?

Hemoglobin of 12 g/dL
Serum albumin of 3.8 g/dL
Blood glucose of 90 mg/dL
Heart rate of 46 bpm (Correct answer)

Correct answer: Heart rate of 46 bpm

Bradycardia (heart rate below 50 bpm) is a medical emergency in anorexia nervosa and requires inpatient stabilization.

Question 45: Long-term use of combined oral contraceptives is most commonly associated with depletion of which nutrient, with implications for women planning pregnancy?

Vitamin C
Magnesium
Folate (Correct answer)
Vitamin E

Correct answer: Folate

Oral contraceptives increase folate metabolism and urinary excretion; adequate folate status is critical before conception to prevent neural tube defects.

Question 46: Which of the following is a function of proteins in the body?

Storing vitamins
Supporting enzyme and hormone production (Correct answer)
Providing energy only
Only aiding in digestion

Correct answer: Supporting enzyme and hormone production

Proteins are crucial for synthesizing enzymes, which act as catalysts for nearly all biochemical reactions, and hormones, which regulate various bodily processes. They also play vital roles in structural support, transport, and immune defense.

Question 47: What is the significance of menu planning in food service management?

It is only for aesthetic purposes
It’s not necessary
It does not affect service
It determines food costs and customer satisfaction (Correct answer)

Correct answer: It determines food costs and customer satisfaction

Menu planning is a critical strategic activity that directly impacts both the financial viability and customer appeal of a food service operation. A well-planned menu balances ingredient costs, labor efficiency, and customer preferences, leading to profitability and repeat business.

Question 48: What role does continuous improvement play in sports nutrition & performance for CDN certified professionals?

It applies only to new professionals in their first year
It drives ongoing enhancement of practices, processes, and outcomes through systematic evaluation (Correct answer)
It focuses exclusively on cost reduction
It is optional and only necessary during certification renewal

Correct answer: It drives ongoing enhancement of practices, processes, and outcomes through systematic evaluation

Continuous improvement is fundamental to professional practice in sports nutrition & performance, involving regular evaluation, feedback integration, and process enhancement to maintain high standards.

Question 49: In the context of CDN certification, what is the most important consideration when implementing weight management counseling?

Ensuring alignment with established standards, stakeholder needs, and best practices (Correct answer)
Minimizing documentation to save time
Completing implementation as quickly as possible regardless of quality
Delegating all responsibilities to junior staff

Correct answer: Ensuring alignment with established standards, stakeholder needs, and best practices

When implementing weight management counseling, CDN professionals must ensure alignment with industry standards and stakeholder needs. Hasty implementation without proper planning often leads to compliance issues and suboptimal outcomes.

Question 50: In treating an athlete with relative energy deficiency in sport (RED-S), the primary nutrition intervention is:

Eliminating all high-fat foods from the diet
Increasing protein intake to 2.5 g/kg/day
Supplementing with iron and B12 only
Restoring energy availability to ≥45 kcal/kg of fat-free mass per day (Correct answer)

Correct answer: Restoring energy availability to ≥45 kcal/kg of fat-free mass per day

RED-S is caused by insufficient energy availability; restoring it to ≥45 kcal/kg FFM/day reverses hormonal, bone, and metabolic disruptions.

Question 51: What is the role of water in metabolism?

It does not affect metabolism
It is used for muscle growth
It regulates body temperature and aids digestion (Correct answer)
It only hydrates the skin

Correct answer: It regulates body temperature and aids digestion

Water is indispensable for countless metabolic reactions, acting as a solvent and transport medium for nutrients and waste products throughout the body. It also plays a critical role in thermoregulation, helping to maintain a stable body temperature, and is essential for the proper digestion and absorption of food.

Question 52: An older adult with stage 3 chronic kidney disease (CKD) and malnutrition requires protein guidance. Which approach is most appropriate?

Provide 1.0–1.2 g/kg/day and monitor renal function closely (Correct answer)
Restrict protein to 0.6 g/kg/day to protect kidneys
Increase protein to 2.0 g/kg/day to reverse malnutrition
Eliminate all animal protein

Correct answer: Provide 1.0–1.2 g/kg/day and monitor renal function closely

Current evidence in non-dialysis CKD with malnutrition supports moderate protein intake of 1.0–1.2 g/kg/day with close monitoring, balancing nutritional rehabilitation against renal progression.

Question 53: Which of the following best describes a key competency required for nutritional genomics & precision in CDN practice?

Memorization of all relevant regulations without understanding context
Reliance on a single methodology for all situations
The ability to work independently without any oversight
Strong analytical skills combined with effective communication and ethical judgment (Correct answer)

Correct answer: Strong analytical skills combined with effective communication and ethical judgment

CDN professionals working in nutritional genomics & precision need analytical skills to assess situations, communication skills to convey findings, and ethical judgment to make sound decisions.

Question 54: What is the primary role of food service management?

To oversee food quality and service operations (Correct answer)
To manage finances
To create marketing campaigns
To handle only employee issues

Correct answer: To oversee food quality and service operations

The primary role of food service management is to ensure the efficient and effective operation of food preparation and delivery. This encompasses maintaining high standards of food quality, safety, and presentation, while also optimizing customer service experiences to ensure satisfaction.

Question 55: In sports nutrition, which strategy best describes 'carbohydrate loading' for endurance athletes?

Consuming simple sugars only within 30 minutes of exercise
Eliminating carbohydrates the week before competition then eating a large carbohydrate meal race morning
Consuming high-fat meals 48 hours before competition to increase fat oxidation
Increasing carbohydrate intake to maximize muscle glycogen stores before an event (Correct answer)

Correct answer: Increasing carbohydrate intake to maximize muscle glycogen stores before an event

Carbohydrate loading involves tapering exercise while increasing carbohydrate intake (8–12 g/kg/day) in the days before endurance events to maximize muscle glycogen storage.

Question 56: How do lipids contribute to metabolism?

They are mainly used for muscle repair
They store energy, form cell membranes, and produce hormones (Correct answer)
They produce enzymes
They are only a source of energy

Correct answer: They store energy, form cell membranes, and produce hormones

Lipids are vital for several metabolic functions, including serving as a concentrated, long-term energy storage. They are also integral components of cell membranes, providing structural integrity and regulating substance passage. Furthermore, lipids are precursors for the synthesis of essential hormones, such as steroid hormones.

Question 57: A dietitian is counseling an older adult on calcium intake. Which combination of factors most impairs calcium absorption?

Adequate stomach acid and sufficient vitamin D
High dairy intake and normal kidney function
Low gastric acid (achlorhydria) and vitamin D deficiency (Correct answer)
High vitamin D and low phytate intake

Correct answer: Low gastric acid (achlorhydria) and vitamin D deficiency

Calcium solubility and absorption requires adequate gastric acid and vitamin D (which induces calcium-binding proteins in intestinal cells); both are often deficient in older adults.

Question 58: A 6-month-old exclusively breastfed infant is at highest risk for deficiency of which nutrient?

Vitamin C
Folate
Calcium
Vitamin D (Correct answer)

Correct answer: Vitamin D

Breast milk is low in vitamin D, so exclusively breastfed infants should receive 400 IU/day supplementation per AAP guidelines.

Question 59: When a CDN professional encounters an unfamiliar challenge in medical nutrition therapy, what is the recommended first course of action?

Postpone addressing the issue indefinitely
Research applicable standards, consult with subject matter experts, and document the approach (Correct answer)
Proceed based on personal intuition alone
Apply the solution used for the most recent similar problem without adaptation

Correct answer: Research applicable standards, consult with subject matter experts, and document the approach

Professional practice requires a methodical approach to unfamiliar challenges: research the applicable standards, consult experts when needed, and document the reasoning for the chosen approach.

Question 60: Motivational interviewing (MI) is particularly useful early in eating disorder treatment because:

It focuses on trauma resolution
It provides detailed meal plans immediately
It addresses ambivalence and builds intrinsic motivation to change (Correct answer)
It directly challenges cognitive distortions

Correct answer: It addresses ambivalence and builds intrinsic motivation to change

MI helps patients explore their own ambivalence about recovery, which is essential before they are ready to engage in behavioral change.

Question 61: Which dextrose concentration is typically used in peripheral parenteral nutrition (PPN) to avoid vein irritation?

10% dextrose or less (Correct answer)
50% dextrose
25% dextrose
5% dextrose

Correct answer: 10% dextrose or less

PPN uses ≤10% dextrose to maintain osmolality below ~900 mOsm/L and prevent thrombophlebitis in peripheral veins.

Question 62: Which electrolyte abnormality is most commonly associated with initiating PN in a patient who has been NPO for an extended period?

Hypernatremia
Hypophosphatemia (Correct answer)
Hyperkalemia
Hypercalcemia

Correct answer: Hypophosphatemia

Hypophosphatemia is the hallmark of refeeding syndrome, occurring when carbohydrate infusion drives phosphorus into cells during anabolic activity.

Question 63: Which of the following best describes a key competency required for weight management counseling in CDN practice?

The ability to work independently without any oversight
Strong analytical skills combined with effective communication and ethical judgment (Correct answer)
Memorization of all relevant regulations without understanding context
Reliance on a single methodology for all situations

Correct answer: Strong analytical skills combined with effective communication and ethical judgment

CDN professionals working in weight management counseling need analytical skills to assess situations, communication skills to convey findings, and ethical judgment to make sound decisions.

Question 64: What is the primary objective of public health nutrition?

To control healthcare costs
To focus on individual health
To monitor food production
To improve the nutritional health of populations (Correct answer)

Correct answer: To improve the nutritional health of populations

Public health nutrition focuses on the broader community rather than individual dietary needs. Its primary objective is to assess, monitor, and improve the nutritional status and dietary patterns of entire populations. This aims to prevent diet-related diseases, promote overall well-being on a large scale, and address health disparities within communities.

Question 65: How should CDN professionals handle confidential information related to sports nutrition & performance?

Follow established protocols for data protection, access control, and disclosure in accordance with applicable regulations (Correct answer)
Delete all records after project completion
Store information without any security measures
Share freely with all colleagues for transparency

Correct answer: Follow established protocols for data protection, access control, and disclosure in accordance with applicable regulations

Confidential information must be handled according to established protocols, regulatory requirements, and professional ethics standards, including proper access control and disclosure procedures.

Question 66: Long-term use of proton pump inhibitors (PPIs) most commonly leads to clinically significant deficiency of which nutrient?

Vitamin B12 (Correct answer)
Vitamin D
Iron
Zinc

Correct answer: Vitamin B12

PPIs suppress gastric acid, which is required to cleave vitamin B12 from dietary protein and for intrinsic factor–mediated absorption.

Question 67: Phosphate supplementation during refeeding should be initiated when serum phosphorus drops below:

1.5 mg/dL
3.5 mg/dL
2.5 mg/dL (Correct answer)
4.0 mg/dL

Correct answer: 2.5 mg/dL

Phosphate supplementation is typically initiated when serum phosphorus falls below 2.5 mg/dL to prevent refeeding syndrome complications.

Question 68: What is the most effective way to measure success in medical nutrition therapy within CDN professional practice?

Compare only with industry averages without considering context
Count only the number of activities completed
Use a combination of quantitative metrics, qualitative assessments, and stakeholder feedback aligned with defined objectives (Correct answer)
Rely solely on supervisor opinion

Correct answer: Use a combination of quantitative metrics, qualitative assessments, and stakeholder feedback aligned with defined objectives

Question 69: Which behavioral therapy component specifically targets the cycle of restricting → binging → purging in bulimia nervosa?

Mindfulness-based stress reduction
Regular eating and elimination of dietary restriction (Correct answer)
Schema therapy
Interpersonal psychotherapy

Correct answer: Regular eating and elimination of dietary restriction

Establishing a pattern of regular, structured eating breaks the restrict-binge-purge cycle that characterizes bulimia nervosa.

Question 70: How does the body regulate blood sugar levels?

By increasing fat storage
By secreting insulin and glucagon to regulate levels (Correct answer)
By increasing glucose intake only
By decreasing metabolism

Correct answer: By secreting insulin and glucagon to regulate levels

The pancreas releases insulin when blood sugar is high, prompting cells to absorb glucose and the liver to store it as glycogen. Conversely, when blood sugar is low, the pancreas releases glucagon, signaling the liver to release stored glucose, thus maintaining a stable blood glucose balance.

Question 71: What is the most effective way to measure success in nutritional genomics & precision within CDN professional practice?

Compare only with industry averages without considering context
Count only the number of activities completed
Rely solely on supervisor opinion
Use a combination of quantitative metrics, qualitative assessments, and stakeholder feedback aligned with defined objectives (Correct answer)

Correct answer: Use a combination of quantitative metrics, qualitative assessments, and stakeholder feedback aligned with defined objectives

Question 72: Which hormone primarily inhibits appetite by signaling satiety to the hypothalamus after a meal?

Neuropeptide Y
Cortisol
Leptin (Correct answer)
Ghrelin

Correct answer: Leptin

Leptin, secreted by adipose tissue, signals the hypothalamus to suppress appetite and increase energy expenditure, reflecting long-term energy stores.

Question 73: In a geriatric patient, which serum marker reflects short-term protein status better than albumin?

Hemoglobin
Prealbumin (transthyretin) (Correct answer)
Transferrin
C-reactive protein

Correct answer: Prealbumin (transthyretin)

Prealbumin has a half-life of 2–3 days vs. albumin's 20 days, making it more sensitive to recent nutritional changes.

Question 74: Which omega-3 fatty acid is critical for brain and retinal development in infants and is preferentially found in breast milk?

EPA (eicosapentaenoic acid)
DHA (docosahexaenoic acid) (Correct answer)
GLA (gamma-linolenic acid)
ALA (alpha-linolenic acid)

Correct answer: DHA (docosahexaenoic acid)

DHA accumulates rapidly in the brain and retina during the third trimester and early infancy, and breast milk provides preformed DHA unlike most standard formulas.

Question 75: What is the role of staff training in food service management?

To increase employee turnover
To create confusion
To improve service quality and efficiency (Correct answer)
To reduce costs only

Correct answer: To improve service quality and efficiency

Staff training is essential for equipping employees with the skills and knowledge needed to perform their roles effectively, from food preparation to customer interaction. This leads to higher quality service, increased operational efficiency, reduced errors, and a more positive customer experience.

Question 76: A dietitian is using the 'Health at Every Size' (HAES) framework for a patient with an eating disorder. This approach prioritizes:

Intuitive eating and well-being over weight outcomes (Correct answer)
Strict caloric counting to normalize intake
Rapid weight restoration as the primary goal
Achieving a BMI within the normal range

Correct answer: Intuitive eating and well-being over weight outcomes

HAES prioritizes health-promoting behaviors, intuitive eating, and psychological well-being independent of weight or BMI outcomes.

Question 77: The 'fear foods' hierarchy used in eating disorder treatment is a tool derived from which theoretical framework?

Narrative therapy
Cognitive behavioral therapy (Correct answer)
Psychodynamic therapy
Solution-focused brief therapy

Correct answer: Cognitive behavioral therapy

The fear foods hierarchy is a CBT exposure tool where patients gradually face avoided foods from least to most feared.

Question 78: How can dietary guidelines improve public health?

By providing evidence-based nutrition recommendations (Correct answer)
By encouraging unhealthy foods
By focusing only on food production
By limiting food availability

Correct answer: By providing evidence-based nutrition recommendations

Dietary guidelines are developed by scientific experts and provide evidence-based recommendations for healthy eating patterns. They serve as a vital public health tool to educate individuals and populations on how to make food choices that promote health, prevent chronic diseases, and improve overall well-being. By offering clear, actionable advice, these guidelines empower people to adopt healthier lifestyles.

Question 79: Pellagra is caused by deficiency of which vitamin, and what is its biochemical role?

Biotin; cofactor for carboxylase enzymes
Riboflavin; component of FAD and FMN
Thiamine; cofactor in pyruvate dehydrogenase
Niacin; component of NAD+ and NADP+ for redox reactions (Correct answer)

Correct answer: Niacin; component of NAD+ and NADP+ for redox reactions

Niacin deficiency causes pellagra (dermatitis, diarrhea, dementia, death); niacin forms NAD+ and NADP+, which are essential electron carriers in energy metabolism.

Question 80: What role does continuous improvement play in renal & cardiac nutrition for CDN certified professionals?

It is optional and only necessary during certification renewal
It focuses exclusively on cost reduction
It drives ongoing enhancement of practices, processes, and outcomes through systematic evaluation (Correct answer)
It applies only to new professionals in their first year

Correct answer: It drives ongoing enhancement of practices, processes, and outcomes through systematic evaluation

Continuous improvement is fundamental to professional practice in renal & cardiac nutrition, involving regular evaluation, feedback integration, and process enhancement to maintain high standards.

Question 81: What role does continuous improvement play in weight management counseling for CDN certified professionals?

It is optional and only necessary during certification renewal
It focuses exclusively on cost reduction
It drives ongoing enhancement of practices, processes, and outcomes through systematic evaluation (Correct answer)
It applies only to new professionals in their first year

Correct answer: It drives ongoing enhancement of practices, processes, and outcomes through systematic evaluation

Continuous improvement is fundamental to professional practice in weight management counseling, involving regular evaluation, feedback integration, and process enhancement to maintain high standards.

Question 82: How should CDN professionals handle confidential information related to medical nutrition therapy?

Follow established protocols for data protection, access control, and disclosure in accordance with applicable regulations (Correct answer)
Share freely with all colleagues for transparency
Store information without any security measures
Delete all records after project completion

Correct answer: Follow established protocols for data protection, access control, and disclosure in accordance with applicable regulations

Confidential information must be handled according to established protocols, regulatory requirements, and professional ethics standards, including proper access control and disclosure procedures.

Question 83: What is the most effective way to measure success in sports nutrition & performance within CDN professional practice?

Use a combination of quantitative metrics, qualitative assessments, and stakeholder feedback aligned with defined objectives (Correct answer)
Count only the number of activities completed
Compare only with industry averages without considering context
Rely solely on supervisor opinion

Correct answer: Use a combination of quantitative metrics, qualitative assessments, and stakeholder feedback aligned with defined objectives

Question 84: In the context of CDN certification, what is the most important consideration when implementing sports nutrition & performance?

Completing implementation as quickly as possible regardless of quality
Ensuring alignment with established standards, stakeholder needs, and best practices (Correct answer)
Minimizing documentation to save time
Delegating all responsibilities to junior staff

Correct answer: Ensuring alignment with established standards, stakeholder needs, and best practices

When implementing sports nutrition & performance, CDN professionals must ensure alignment with industry standards and stakeholder needs. Hasty implementation without proper planning often leads to compliance issues and suboptimal outcomes.

Question 85: How should CDN professionals handle confidential information related to nutritional genomics & precision?

Delete all records after project completion
Share freely with all colleagues for transparency
Store information without any security measures
Follow established protocols for data protection, access control, and disclosure in accordance with applicable regulations (Correct answer)

Correct answer: Follow established protocols for data protection, access control, and disclosure in accordance with applicable regulations

Confidential information must be handled according to established protocols, regulatory requirements, and professional ethics standards, including proper access control and disclosure procedures.

Question 86: What is the most effective way to measure success in renal & cardiac nutrition within CDN professional practice?

Use a combination of quantitative metrics, qualitative assessments, and stakeholder feedback aligned with defined objectives (Correct answer)
Rely solely on supervisor opinion
Count only the number of activities completed
Compare only with industry averages without considering context

Correct answer: Use a combination of quantitative metrics, qualitative assessments, and stakeholder feedback aligned with defined objectives

Question 87: What role does continuous improvement play in eating disorder treatment for CDN certified professionals?

It focuses exclusively on cost reduction
It applies only to new professionals in their first year
It drives ongoing enhancement of practices, processes, and outcomes through systematic evaluation (Correct answer)
It is optional and only necessary during certification renewal

Correct answer: It drives ongoing enhancement of practices, processes, and outcomes through systematic evaluation

Continuous improvement is fundamental to professional practice in eating disorder treatment, involving regular evaluation, feedback integration, and process enhancement to maintain high standards.

Question 88: According to the Transtheoretical Model (Stages of Change), a patient who acknowledges a dietary problem but is not planning to change within the next 30 days is in which stage?

Preparation
Action
Contemplation (Correct answer)
Precontemplation

Correct answer: Contemplation

Contemplation is characterized by awareness of the problem and ambivalence about change, without commitment to action within 30 days.

Question 89: Which of the following best describes a key competency required for medical nutrition therapy in CDN practice?

Reliance on a single methodology for all situations
The ability to work independently without any oversight
Memorization of all relevant regulations without understanding context
Strong analytical skills combined with effective communication and ethical judgment (Correct answer)

Correct answer: Strong analytical skills combined with effective communication and ethical judgment

CDN professionals working in medical nutrition therapy need analytical skills to assess situations, communication skills to convey findings, and ethical judgment to make sound decisions.

Question 90: Which phase of digestion is stimulated by the sight and smell of food before eating begins?

Gastric phase
Absorptive phase
Intestinal phase
Cephalic phase (Correct answer)

Correct answer: Cephalic phase

The cephalic phase is the neurally mediated response to food cues (sight, smell, taste) that prepares the GI tract by stimulating saliva and gastric secretions before food arrives.

Question 91: Which carbohydrate is contraindicated in infants under 12 months due to risk of infant botulism?

Honey (Correct answer)
Pasteurized fruit juice
Pureed sweet potato
Rice cereal

Correct answer: Honey

Honey may contain Clostridium botulinum spores that produce toxin in the infant gut, causing potentially fatal infant botulism; it should not be given before age 1.

Question 92: What is the primary function of carbohydrates in the human body?

To provide energy (Correct answer)
To regulate body temperature
To provide essential fatty acids
To build muscle tissue

Correct answer: To provide energy

Carbohydrates are the body's primary and most readily available source of energy. They are broken down into glucose, which cells use to produce ATP, fueling all metabolic processes and physical activities. This makes them essential for daily bodily functions.

Question 93: Isoniazid (INH), used in the treatment of tuberculosis, acts as a structural antagonist to which B vitamin, frequently necessitating supplementation?

Thiamine (B1)
Cobalamin (B12)
Riboflavin (B2)
Pyridoxine (B6) (Correct answer)

Correct answer: Pyridoxine (B6)

Isoniazid structurally resembles pyridoxine and competitively inhibits its conversion to the active coenzyme pyridoxal-5-phosphate, causing peripheral neuropathy.

Question 94: How do lipids contribute to metabolism?

They are only a source of energy
They store energy, form cell membranes, and produce hormones (Correct answer)
They are mainly used for muscle repair
They produce enzymes

Correct answer: They store energy, form cell membranes, and produce hormones

Lipids serve as a concentrated, long-term energy reserve for the body. They are also fundamental components of all cell membranes, providing structural integrity, and are precursors for the synthesis of vital hormones, including steroid hormones.

Question 95: A patient on PN develops essential fatty acid deficiency (EFAD). Which clinical sign is characteristic of this condition?

Scaly dermatitis and poor wound healing (Correct answer)
Peripheral neuropathy
Night blindness
Hair loss and nail brittleness

Correct answer: Scaly dermatitis and poor wound healing

EFAD presents with scaly dermatitis, alopecia, and impaired wound healing due to inadequate linoleic and alpha-linolenic acid.

Question 96: Which anthropometric index is most appropriate for assessing nutritional status in children aged 2–18 years?

BMI-for-age percentile (Correct answer)
Waist-to-hip ratio
Mid-upper arm circumference
Weight-for-height Z-score

Correct answer: BMI-for-age percentile

BMI-for-age percentile accounts for normal growth patterns and is the standard screening tool for overweight and obesity in children 2–18 years.

Question 97: When counseling a patient from a food-insecure household about dietary improvement, which approach is most appropriate?

Defer all dietary advice until food security is established
Recommend organic and specialty diet foods for optimal nutrition
Focus on affordable, nutrient-dense foods and local food assistance resources (Correct answer)
Provide standard USDA MyPlate recommendations without modification

Correct answer: Focus on affordable, nutrient-dense foods and local food assistance resources

Effective counseling for food-insecure clients prioritizes affordable, accessible, nutrient-dense options and connects them with SNAP, food banks, or WIC resources.

Question 98: What is the primary function of carbohydrates in the human body?

To build muscle tissue
To regulate body temperature
To provide essential fatty acids
To provide energy (Correct answer)

Correct answer: To provide energy

Carbohydrates are the body's main source of energy, being readily converted into glucose for immediate use by cells. This energy powers all bodily functions, from brain activity to muscle contraction, making them essential for daily living.

Question 99: Zinc deficiency in a toddler is most likely to impair which function?

Thyroid hormone synthesis
Blood clotting
Linear growth and immune function (Correct answer)
Oxygen transport

Correct answer: Linear growth and immune function

Zinc is critical for cell division, growth, and immune defense; deficiency commonly manifests as growth faltering, increased infections, and dermatitis in young children.

Question 100: What is the primary role of intrinsic factor in nutrition?

Transporting folate across the intestinal epithelium
Facilitating iron absorption in the duodenum
Activating vitamin D in the kidney
Binding vitamin B12 for absorption in the terminal ileum (Correct answer)

Correct answer: Binding vitamin B12 for absorption in the terminal ileum

Intrinsic factor, secreted by gastric parietal cells, binds vitamin B12 and the complex is absorbed by specific receptors in the terminal ileum.

Question 101: How should CDN professionals handle confidential information related to weight management counseling?

Share freely with all colleagues for transparency
Delete all records after project completion
Follow established protocols for data protection, access control, and disclosure in accordance with applicable regulations (Correct answer)
Store information without any security measures

Correct answer: Follow established protocols for data protection, access control, and disclosure in accordance with applicable regulations

Confidential information must be handled according to established protocols, regulatory requirements, and professional ethics standards, including proper access control and disclosure procedures.

Question 102: Which technique in nutrition counseling involves helping a client identify discrepancies between their current behavior and their stated values or goals?

Shaping
Contingency management
Developing discrepancy (a core MI technique) (Correct answer)
Confrontation

Correct answer: Developing discrepancy (a core MI technique)

Developing discrepancy highlights the gap between the client's current behavior and their goals or values, creating internal motivation for change without external pressure.

Question 103: What is the most effective way to measure success in weight management counseling within CDN professional practice?

Use a combination of quantitative metrics, qualitative assessments, and stakeholder feedback aligned with defined objectives (Correct answer)
Rely solely on supervisor opinion
Compare only with industry averages without considering context
Count only the number of activities completed

Correct answer: Use a combination of quantitative metrics, qualitative assessments, and stakeholder feedback aligned with defined objectives

Question 104: Which of the following best describes a key competency required for renal & cardiac nutrition in CDN practice?

Memorization of all relevant regulations without understanding context
The ability to work independently without any oversight
Strong analytical skills combined with effective communication and ethical judgment (Correct answer)
Reliance on a single methodology for all situations

Correct answer: Strong analytical skills combined with effective communication and ethical judgment

CDN professionals working in renal & cardiac nutrition need analytical skills to assess situations, communication skills to convey findings, and ethical judgment to make sound decisions.

Question 105: Which metabolic pathway produces ATP in cells?

Cellular respiration (Correct answer)
Fermentation
Lactic acid production
Photosynthesis

Correct answer: Cellular respiration

Cellular respiration is the primary metabolic pathway where glucose and other organic molecules are broken down to generate adenosine triphosphate (ATP). ATP is the main energy currency used by cells to power all their activities, from muscle contraction to active transport.

Question 106: What is the recommended caloric goal (kcal/kg/day) for most non-obese hospitalized adults requiring nutrition support?

25–30 kcal/kg/day (Correct answer)
10–15 kcal/kg/day
35–40 kcal/kg/day
45–50 kcal/kg/day

Correct answer: 25–30 kcal/kg/day

ASPEN guidelines recommend 25–30 kcal/kg/day as a general target for hospitalized adults to meet metabolic needs without overfeeding.

Question 107: Which medical complication is most associated with chronic laxative abuse in bulimia nervosa?

Hypernatremia
Hyperkalemia
Hypercalcemia
Hypokalemia (Correct answer)

Correct answer: Hypokalemia

Chronic laxative abuse causes significant potassium loss through the GI tract, leading to hypokalemia.

Question 108: Which macronutrient is the body's primary source of quick energy?

Proteins
Vitamins
Fats
Carbohydrates (Correct answer)

Correct answer: Carbohydrates

Carbohydrates are the body's most readily available and preferred source of quick energy. They are rapidly broken down into glucose, which cells use immediately for fuel, making them ideal for meeting immediate energy demands during physical activity and daily functions.

Question 109: A 3-year-old presents with a distended abdomen, edema, and skin lesions, but adequate caloric intake. The most likely diagnosis is:

Marasmus
Iron-deficiency anemia
Rickets
Kwashiorkor (Correct answer)

Correct answer: Kwashiorkor

Kwashiorkor results from severe protein deficiency with relatively adequate caloric intake, presenting with edema, skin/hair changes, and fatty liver.

Question 110: Which counseling approach is most evidence-based for changing dietary behaviors in patients with chronic disease?

Didactic nutrition education lectures
Cognitive-behavioral therapy (CBT) adapted for nutrition (Correct answer)
Supplement-based interventions
Strict meal plans with no patient input

Correct answer: Cognitive-behavioral therapy (CBT) adapted for nutrition

CBT for nutrition addresses thought patterns, beliefs, and behaviors that influence food choices, with strong evidence in chronic disease management.

Question 111: Self-efficacy, as described by Bandura's Social Cognitive Theory, is best defined as:

A person's motivation based on rewards and punishments
A person's knowledge of nutrition principles
The influence of social norms on dietary choices
A person's belief in their ability to perform a specific behavior successfully (Correct answer)

Correct answer: A person's belief in their ability to perform a specific behavior successfully

Self-efficacy is a person's confidence in their own capability to execute a behavior — a strong predictor of dietary behavior change.

Question 112: Which lab value is most important to monitor for hepatic complications in a patient on long-term PN?

Serum bilirubin and liver enzymes (ALT/AST) (Correct answer)
Serum creatinine
Blood urea nitrogen (BUN)
Serum albumin

Correct answer: Serum bilirubin and liver enzymes (ALT/AST)

Elevated bilirubin and liver enzymes indicate PN-associated liver disease (PNALD), a common complication of long-term parenteral nutrition.

Question 113: What is a common challenge in addressing nutrition in low-income communities?

Abundant food availability
Limited access to nutritious foods (Correct answer)
Perfect nutrition education
High income

Correct answer: Limited access to nutritious foods

A significant challenge in improving nutrition in low-income communities is the limited access to readily available and affordable nutritious food options. These areas often have fewer supermarkets offering fresh produce and a higher concentration of convenience stores selling processed, high-calorie, low-nutrient foods. This disparity makes it difficult for residents to maintain a healthy diet, contributing to health inequalities.

Question 114: What is a critical factor in managing food costs?

Ignoring portion sizes
Increasing food waste
Purchasing only expensive ingredients
Monitoring portions and sourcing efficiently (Correct answer)

Correct answer: Monitoring portions and sourcing efficiently

Managing food costs effectively involves careful control over portion sizes to prevent waste and ensure consistent profitability. Additionally, efficient sourcing, which includes negotiating with suppliers and selecting cost-effective ingredients, significantly contributes to controlling overall expenses without compromising quality.

Question 115: When a CDN professional encounters an unfamiliar challenge in pediatric & geriatric nutrition, what is the recommended first course of action?

Postpone addressing the issue indefinitely
Research applicable standards, consult with subject matter experts, and document the approach (Correct answer)
Apply the solution used for the most recent similar problem without adaptation
Proceed based on personal intuition alone

Correct answer: Research applicable standards, consult with subject matter experts, and document the approach

Professional practice requires a methodical approach to unfamiliar challenges: research the applicable standards, consult experts when needed, and document the reasoning for the chosen approach.

Question 116: Enhanced Cognitive Behavioral Therapy (CBT-E) for eating disorders adds which modules compared to standard CBT?

Pharmacotherapy and nutritional counseling
Perfectionism, low self-esteem, interpersonal difficulties, and mood intolerance (Correct answer)
Mindfulness, yoga, and body scan techniques
Family therapy and parent training components

Correct answer: Perfectionism, low self-esteem, interpersonal difficulties, and mood intolerance

CBT-E's 'enhanced' modules address perfectionism, low self-esteem, interpersonal difficulties, and mood intolerance as additional maintaining mechanisms.

Question 117: The antibiotic trimethoprim reduces availability of which nutrient by competitively inhibiting the enzyme dihydrofolate reductase?

Vitamin B12
Folate (Correct answer)
Thiamine
Vitamin C

Correct answer: Folate

Trimethoprim inhibits dihydrofolate reductase, the enzyme required to convert dietary folate into its active tetrahydrofolate form needed for DNA synthesis.

Question 118: Which assessment method most accurately measures total body fat percentage in a clinical setting?

Dual-energy X-ray absorptiometry (DXA) (Correct answer)
BMI calculation
Skinfold calipers (3-site)
Bioelectrical impedance analysis (BIA)

Correct answer: Dual-energy X-ray absorptiometry (DXA)

DXA is considered the gold standard for body composition assessment in clinical settings because it directly measures fat mass, lean mass, and bone mineral density.

Question 119: Dental erosion on the lingual surfaces of maxillary teeth is a clinical sign most consistent with:

Excessive use of diet pills
Prolonged food restriction
Frequent self-induced vomiting (Correct answer)
Chronic laxative use

Correct answer: Frequent self-induced vomiting

Gastric acid from self-induced vomiting erodes the lingual (tongue-side) surfaces of upper front teeth, a finding called perimolysis.

Question 120: Metformin, a first-line medication for type 2 diabetes, is associated with reduced absorption of which vitamin over time?

Vitamin D
Vitamin A
Folate
Vitamin B12 (Correct answer)

Correct answer: Vitamin B12

Metformin interferes with calcium-dependent absorption of the vitamin B12–intrinsic factor complex in the terminal ileum.

Question 121: How does health and safety regulations affect food service operations?

They don’t have much impact
They slow down operations
They ensure food safety and compliance (Correct answer)
They increase costs significantly

Correct answer: They ensure food safety and compliance

Health and safety regulations are fundamental to food service operations as they establish standards for food handling, storage, and preparation, protecting both customers and staff from foodborne illnesses and hazards. Adherence to these regulations is legally mandated and critical for maintaining public trust and operational integrity.

Question 122: When a CDN professional encounters an unfamiliar challenge in renal & cardiac nutrition, what is the recommended first course of action?

Postpone addressing the issue indefinitely
Apply the solution used for the most recent similar problem without adaptation
Research applicable standards, consult with subject matter experts, and document the approach (Correct answer)
Proceed based on personal intuition alone

Correct answer: Research applicable standards, consult with subject matter experts, and document the approach

Professional practice requires a methodical approach to unfamiliar challenges: research the applicable standards, consult experts when needed, and document the reasoning for the chosen approach.

Question 123: When a CDN professional encounters an unfamiliar challenge in nutritional genomics & precision, what is the recommended first course of action?

Proceed based on personal intuition alone
Research applicable standards, consult with subject matter experts, and document the approach (Correct answer)
Postpone addressing the issue indefinitely
Apply the solution used for the most recent similar problem without adaptation

Correct answer: Research applicable standards, consult with subject matter experts, and document the approach

Professional practice requires a methodical approach to unfamiliar challenges: research the applicable standards, consult experts when needed, and document the reasoning for the chosen approach.

Question 124: What is the primary indication for initiating parenteral nutrition (PN) in a hospitalized patient?

Non-functional or inaccessible GI tract for more than 7 days (Correct answer)
Need for supplemental vitamins
Patient preference for IV nutrition
Mild dysphagia with adequate oral intake

Correct answer: Non-functional or inaccessible GI tract for more than 7 days

PN is indicated when the GI tract is non-functional, inaccessible, or cannot meet nutritional needs enterally for an extended period.

Question 125: During refeeding of a severely malnourished anorexia patient, which electrolyte requires closest monitoring during the first 72 hours?

Calcium
Magnesium
Sodium
Phosphorus (Correct answer)

Correct answer: Phosphorus

Hypophosphatemia is the hallmark of refeeding syndrome and the electrolyte requiring most urgent monitoring.

Commission on Dietetic Registration (CDR) Registration Examination for Dietitian Nutritionists

This exam certifies entry-level competence for Registered Dietitian Nutritionists (RDNs) to provide food and nutrition services.

125

Questions

180 min

Time Limit

25%

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Sources & references

Exam facts on this page (fees, format, dates, passing scores) are checked against these official sources; the date is our last check. Editorial policy

eservices.nysed.gov — Fees · verified Oct 2026
op.nysed.gov — Renewal, eligibility · verified Oct 2026
pearsonvue.com — Test delivery · verified Oct 2026
cdrnet.org — Test dates, exam format, passing score, retake policy, score release, time limit, fees, retake fee · verified Oct 2026