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

Question 1: When conducting a standardized recipe yield test, a roast beef yielded 68% after cooking. If you need 50 servings of 4 oz each, how many pounds of raw beef must be purchased?

14.7 lbs
18.4 lbs (Correct answer)
22.1 lbs
12.5 lbs

Correct answer: 18.4 lbs

Required cooked weight = 50 × 4 oz = 200 oz = 12.5 lbs; raw weight needed = 12.5 ÷ 0.68 = 18.4 lbs.

Question 2: In the context of CDN certification, what is the most important consideration when implementing cultural competency in nutrition?

Completing implementation as quickly as possible regardless of quality
Minimizing documentation to save time
Delegating all responsibilities to junior staff
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 cultural competency in nutrition, 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 3: Which evidence-based weight loss intervention has demonstrated the greatest long-term (>1 year) weight loss outcomes compared to lifestyle modification alone?

Elimination diets (e.g., gluten-free for non-celiac)
Meal replacement programs combined with behavioral therapy (Correct answer)
Herbal supplement protocols
Detox and cleanse programs

Correct answer: Meal replacement programs combined with behavioral therapy

Structured meal replacement programs combined with behavioral counseling consistently show superior weight loss at 1 year compared to conventional dietary advice alone.

Question 4: Which dietary pattern is most strongly supported by evidence for reducing cardiovascular disease risk?

Very low-calorie liquid diet
Low-fat, high-carbohydrate diet
Carnivore diet
Mediterranean diet (Correct answer)

Correct answer: Mediterranean diet

The Mediterranean diet, rich in olive oil, fish, fruits, vegetables, and whole grains, has the strongest evidence base for reducing CVD morbidity and mortality.

Question 5: A dietitian identifies that a client's weight gain is largely driven by liquid calorie consumption from sweetened beverages. The MOST effective first counseling step is:

Prescribing artificial sweeteners as direct replacements
Ignoring beverages and focusing only on solid food intake
Recommending immediate complete elimination of all beverages except water
Helping the client identify and gradually replace high-calorie beverages with lower-calorie alternatives (Correct answer)

Correct answer: Helping the client identify and gradually replace high-calorie beverages with lower-calorie alternatives

A gradual substitution approach is more sustainable and behaviorally feasible than immediate elimination, improving adherence and long-term success.

Question 6: Which serum protein is considered the LEAST reliable marker of nutritional status in a patient with acute inflammation or infection?

Albumin
All of the above are unreliable in acute inflammation (Correct answer)
Transferrin
Prealbumin

Correct answer: All of the above are unreliable in acute inflammation

Albumin, prealbumin, and transferrin are all negative acute-phase proteins whose levels decline during inflammation regardless of nutritional status, making them unreliable markers of nutrition in acute illness.

Question 7: Which epidemiological measure describes the proportion of a population that has a disease at a specific point in time?

Point prevalence (Correct answer)
Mortality rate
Period prevalence
Incidence rate

Correct answer: Point prevalence

Point prevalence is the proportion of individuals with a condition at one specific moment in time.

Question 8: Which carbohydrate is contraindicated in infants under 12 months due to risk of infant botulism?

Pasteurized fruit juice
Honey (Correct answer)
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 9: A patient with congestive heart failure and cardiac cachexia has poor appetite. What caloric density strategy is most appropriate for oral supplements?

Clear liquid diet only
Fat-free supplements to protect the heart
High-calorie dense formula (≥1.5–2.0 kcal/mL) in small portions (Correct answer)
Standard 1.0 kcal/mL formula with large volumes

Correct answer: High-calorie dense formula (≥1.5–2.0 kcal/mL) in small portions

High-calorie dense formulas allow patients with poor appetite and volume restrictions to meet caloric goals in smaller, more tolerable amounts.

Question 10: Which of the following best describes 'emic' versus 'etic' perspectives in cultural nutrition assessment?

Emic means evidence-based; etic means culturally influenced
Emic refers to external scientific observation; etic refers to the patient's internal viewpoint
Emic reflects the insider's (patient's) cultural viewpoint; etic reflects the outsider's (practitioner's) perspective (Correct answer)
Emic applies to non-Western cultures; etic applies to Western populations

Correct answer: Emic reflects the insider's (patient's) cultural viewpoint; etic reflects the outsider's (practitioner's) perspective

In anthropology and nutrition, 'emic' is the insider cultural perspective and 'etic' is the outsider or researcher perspective.

Question 11: How should CDN professionals handle confidential information related to sports nutrition & performance?

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
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 12: 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
Proceed based on personal intuition alone
Postpone addressing the issue indefinitely
Research applicable standards, consult with subject matter experts, and document the approach (Correct answer)

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 13: Why is nutrition education important in public health?

It focuses only on food production
It promotes unhealthy eating habits
It helps individuals make informed health decisions (Correct answer)
It reduces the cost of healthcare

Correct answer: It helps individuals make informed health decisions

Nutrition education empowers individuals with the knowledge and skills to understand the crucial link between diet and health outcomes. By providing evidence-based information, it enables people to make informed and healthier food choices for themselves and their families. This ultimately contributes to the prevention of chronic diseases and the overall improvement of public health.

Question 14: An 85-year-old with decreased appetite and 10% unintentional weight loss over 6 months meets criteria for which nutritional condition?

Severe malnutrition (Correct answer)
Overweight
Mild malnutrition
Moderate 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 15: The antibiotic trimethoprim reduces availability of which nutrient by competitively inhibiting the enzyme dihydrofolate reductase?

Vitamin B12
Vitamin C
Folate (Correct answer)
Thiamine

Correct answer: Folate

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

Question 16: What is the most effective way to measure success in pediatric & geriatric nutrition 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
Rely solely on supervisor opinion
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 17: What is the Estimated Average Requirement (EAR) used for in dietary planning?

Determining the minimum intake to prevent deficiency in all individuals
Setting the upper safe intake limit for a nutrient
Calculating the average intake observed in population surveys
Estimating the intake that meets the needs of 50% of a healthy population (Correct answer)

Correct answer: Estimating the intake that meets the needs of 50% of a healthy population

The EAR is the daily intake estimated to meet the requirements of half of all healthy individuals in a group and is used to assess population adequacy.

Question 18: What is the primary indication for initiating parenteral nutrition (PN) in a hospitalized patient?

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

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 19: Which serum marker, though not specific, is often monitored as a proxy for nutritional rehabilitation progress in anorexia nervosa?

C-reactive protein
Prealbumin (transthyretin) (Correct answer)
Ferritin
Homocysteine

Correct answer: Prealbumin (transthyretin)

Prealbumin has a short half-life (~2 days), making it a more sensitive marker of recent nutritional status changes than albumin.

Question 20: What is the recommended protein intake (g/kg/day) for a healthy older adult (>65 years) to preserve muscle mass?

1.0–1.2 g/kg/day (Correct answer)
0.6–0.7 g/kg/day
1.8–2.0 g/kg/day
0.8 g/kg/day

Correct answer: 1.0–1.2 g/kg/day

Research supports 1.0–1.2 g/kg/day of protein for older adults to counter anabolic resistance and preserve lean body mass.

Question 21: A client with a history of yo-yo dieting presents for weight management. Which metabolic consequence is MOST associated with repeated weight cycling?

Improved insulin sensitivity over time
Decreased visceral adiposity
Permanent increase in resting metabolic rate
Loss of lean body mass with preferential fat regain (Correct answer)

Correct answer: Loss of lean body mass with preferential fat regain

Weight cycling typically results in a progressive loss of lean mass and preferential regain of fat, worsening body composition over time.

Question 22: In the Health Belief Model, 'perceived barriers' refer to which concept?

The obstacles a person believes exist that prevent healthy behavior (Correct answer)
External cues that trigger health-related decisions
A person's belief that they are susceptible to a health condition
The perceived benefits of taking a health action

Correct answer: The obstacles a person believes exist that prevent healthy behavior

Perceived barriers are the individual's beliefs about the obstacles (cost, time, taste) that make healthy behavior difficult or impossible.

Question 23: Which electrolyte abnormality is most commonly associated with refeeding syndrome?

Hypernatremia
Hypophosphatemia (Correct answer)
Hyperkalemia
Hypercalcemia

Correct answer: Hypophosphatemia

Refeeding syndrome is characterized by severe hypophosphatemia as insulin release drives phosphate into cells when carbohydrates are reintroduced.

Question 24: Which enteral formula is most appropriate for a patient with glucose intolerance and need for tube feeding?

Elemental formula
Carbohydrate-modified formula (Correct answer)
Standard polymeric formula
High-protein formula

Correct answer: Carbohydrate-modified formula

Carbohydrate-modified formulas (e.g., Glucerna) are designed to blunt postprandial glucose spikes in patients with glucose intolerance.

Question 25: A sports dietitian is advising on caffeine timing for a 10 AM competition. Based on pharmacokinetics, when should the athlete consume caffeine?

Midnight before competition
During warm-up at 9:45 AM
9:00 AM (60 minutes before) (Correct answer)
8:00 AM (120 minutes before)

Correct answer: 9:00 AM (60 minutes before)

Caffeine reaches peak plasma concentration approximately 60 minutes after ingestion, so consuming it 60 minutes before a 10 AM competition (at 9 AM) is optimal for performance benefits.

Question 26: The 'thrifty gene hypothesis' proposed by Neel (1962) is most relevant to modern nutritional genomics in explaining:

The adaptive benefits of lactase persistence in Northern Europe
How omega-3 genes evolved in coastal populations
Why vitamin deficiencies are more common in women
Genetic predisposition to obesity and type 2 diabetes in populations with historically feast-famine cycles (Correct answer)

Correct answer: Genetic predisposition to obesity and type 2 diabetes in populations with historically feast-famine cycles

The thrifty gene hypothesis proposes that alleles favoring energy storage were advantageous during food scarcity but now promote obesity and T2DM in environments with continuous food abundance.

Question 27: Long-term use of aluminum-containing antacids can deplete which mineral by forming insoluble complexes in the gastrointestinal tract?

Calcium
Phosphate (Correct answer)
Iron
Magnesium

Correct answer: Phosphate

Aluminum hydroxide binds dietary phosphate in the gut forming insoluble aluminum phosphate, reducing phosphate absorption and potentially causing hypophosphatemia.

Question 28: Which condition in older adults is characterized by loss of skeletal muscle mass, strength, and function?

Kwashiorkor
Cachexia
Sarcopenia (Correct answer)
Osteopenia

Correct answer: Sarcopenia

Sarcopenia is the age-related decline in skeletal muscle mass and function and is a major contributor to disability in older adults.

Question 29: Which hormonal change during weight loss most directly drives increased hunger and is considered a key barrier to maintenance?

Increased adiponectin
Decreased glucagon
Decreased cortisol
Increased ghrelin (Correct answer)

Correct answer: Increased ghrelin

Ghrelin, the primary hunger hormone, increases significantly during and after weight loss, creating persistent appetite signals that drive regain.

Question 30: A patient presents with night blindness and dry, scaly skin. These clinical signs are most consistent with deficiency of:

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

Correct answer: Vitamin A

Vitamin A deficiency causes nyctalopia (night blindness) due to impaired rhodopsin synthesis and xerosis (dry, scaly skin) due to impaired epithelial differentiation.

Question 31: What is the primary objective of public health nutrition?

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

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 32: A Mexican-American patient relies heavily on corn tortillas, beans, and rice. The dietitian should recognize that this dietary pattern:

Provides complementary proteins and fiber that support nutritional goals (Correct answer)
Is acceptable only if the patient is underweight
Lacks sufficient calcium and should be entirely revised
Is nutritionally inadequate and should be replaced with a Western diet

Correct answer: Provides complementary proteins and fiber that support nutritional goals

Traditional Mexican staples like beans, corn, and rice together provide complementary amino acids, fiber, and essential nutrients.

Question 33: A waist circumference of >102 cm in men and >88 cm in women indicates increased risk for which condition cluster?

Renal disease and electrolyte imbalance
Osteoporosis and fracture risk
Malnutrition and micronutrient deficiency
Metabolic syndrome and cardiovascular disease (Correct answer)

Correct answer: Metabolic syndrome and cardiovascular disease

These waist circumference thresholds are established criteria for abdominal obesity, a major component of metabolic syndrome associated with cardiovascular risk.

Question 34: The '5 A's' counseling framework used in weight management stands for:

Assess, Approach, Act, Analyze, Adjust
Ask, Advise, Assess, Assist, Arrange (Correct answer)
Ask, Accept, Assist, Audit, Arrange
Acknowledge, Address, Aim, Apply, Advance

Correct answer: Ask, Advise, Assess, Assist, Arrange

The 5 A's (Ask, Advise, Assess, Assist, Arrange) is a structured brief counseling framework adapted for obesity and lifestyle behavior change.

Question 35: Which nutrition intervention is recommended for a patient with non-alcoholic fatty liver disease (NAFLD)?

Protein restriction to <0.5 g/kg/day
5–10% weight loss through caloric restriction and increased physical activity (Correct answer)
Supplementation with high-dose vitamin A
High-fat, low-carbohydrate diet with no caloric restriction

Correct answer: 5–10% weight loss through caloric restriction and increased physical activity

A 5–10% reduction in body weight through diet and exercise has been shown to significantly improve liver histology and reduce steatosis in NAFLD.

Question 36: A dietitian working with Latino patients notes that many prefer to receive nutrition advice from family members rather than healthcare providers. This is BEST described as:

A sign that the patient distrusts medical professionals
Non-compliance with evidence-based practice
Familismo, a cultural value emphasizing family involvement in health decisions (Correct answer)
A barrier that should be eliminated through patient education

Correct answer: Familismo, a cultural value emphasizing family involvement in health decisions

Familismo is a core Latino cultural value that prioritizes family input in personal decisions, including health and nutrition.

Question 37: What is the recommended caloric goal (kcal/kg/day) for most non-obese hospitalized adults requiring nutrition support?

35–40 kcal/kg/day
25–30 kcal/kg/day (Correct answer)
10–15 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 38: A patient with bulimia nervosa reports feeling 'numb' and turning to bingeing to cope with emotional distress. Which therapy is best suited for targeting emotion regulation deficits?

Cognitive processing therapy
Prolonged exposure therapy
Dialectical behavior therapy (DBT) (Correct answer)
Acceptance and commitment therapy

Correct answer: Dialectical behavior therapy (DBT)

DBT specifically targets emotion dysregulation through distress tolerance, emotion regulation, and mindfulness skills.

Question 39: Which condition is characterized by fat malabsorption, steatorrhea, and is most likely to cause deficiencies of fat-soluble vitamins (A, D, E, K)?

Lactose intolerance
Irritable bowel syndrome (IBS)
Exocrine pancreatic insufficiency (EPI) (Correct answer)
Helicobacter pylori infection

Correct answer: Exocrine pancreatic insufficiency (EPI)

Exocrine pancreatic insufficiency reduces lipase and colipase secretion, impairing fat digestion and absorption, leading to steatorrhea and fat-soluble vitamin deficiencies.

Question 40: The PRECEDE-PROCEED model is used in public health nutrition primarily to:

Analyze food composition databases
Screen individuals for nutritional deficiencies
Calculate dietary reference intakes for populations
Plan and evaluate health promotion programs (Correct answer)

Correct answer: Plan and evaluate health promotion programs

PRECEDE-PROCEED is a comprehensive planning framework used to design, implement, and evaluate community health promotion programs.

Question 41: For a client who is 30% above ideal body weight, an initial weight loss goal of _____ is considered clinically meaningful for reducing comorbidities.

3-5% (Correct answer)
15-20%
1-2%
25-30%

Correct answer: 3-5%

Clinical evidence shows that even a 3-5% weight loss produces meaningful improvements in metabolic markers including blood glucose, triglycerides, and blood pressure.

Question 42: Which amino acid supplementation strategy is most supported by evidence for reducing exercise-induced muscle damage in strength athletes?

BCAA 10g intra-workout (Correct answer)
Glutamine 20g pre-workout
Tryptophan 2g pre-workout
Leucine 5g post-workout

Correct answer: BCAA 10g intra-workout

Branched-chain amino acid (BCAA) supplementation intra-workout has the strongest evidence base for attenuating exercise-induced muscle damage and soreness.

Question 43: Which scheduling approach assigns staff to fixed shifts (e.g., always 7am–3pm) regardless of daily production needs?

Traditional scheduling (Correct answer)
Cross-training rotation
Self-scheduling
Flexible scheduling

Correct answer: Traditional scheduling

Traditional scheduling assigns employees to fixed, predictable shifts, which simplifies management but may not align staffing with variable production demands.

Question 44: A registered dietitian designing a school nutrition program applies the social-ecological model. Which level of intervention focuses on school cafeteria layout changes?

Community
Interpersonal
Individual
Organizational/institutional (Correct answer)

Correct answer: Organizational/institutional

Cafeteria layout changes operate at the organizational/institutional level, modifying the physical environment within the school setting.

Question 45: What is the recommended fluid restriction for a stable hemodialysis patient to limit interdialytic weight gain?

3 liters/day
Urine output plus 750-1000 mL/day (Correct answer)
No restriction needed
500-750 mL/day

Correct answer: Urine output plus 750-1000 mL/day

Fluid allowance for dialysis patients is typically residual urine output plus 750-1000 mL/day to prevent excessive interdialytic weight gain.

Question 46: In MNT for HIV/AIDS, what is the primary goal of nutrition intervention?

Eliminate dairy to reduce inflammation
Maintain lean body mass and prevent wasting (Correct answer)
Restrict fat to prevent lipodystrophy
Limit carbohydrates to control lipids

Correct answer: Maintain lean body mass and prevent wasting

Preserving lean body mass is the primary nutrition goal in HIV/AIDS as wasting syndrome significantly worsens prognosis and quality of life.

Question 47: What is the role of water in metabolism?

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

Correct answer: It regulates body temperature and aids digestion

Water is indispensable for metabolism, acting as a solvent for nutrients and waste products, and participating in numerous biochemical reactions. It also plays a critical role in maintaining body temperature through sweating and is essential for the proper breakdown and absorption of food in the digestive system.

Question 48: A client's DEXA scan shows 38% body fat with normal BMI. This condition is best described as:

Normal weight obesity (Correct answer)
Metabolically healthy obesity
Sarcopenic obesity
Central adiposity syndrome

Correct answer: Normal weight obesity

Normal weight obesity (NWO) refers to a normal BMI combined with excess body fat percentage, which carries independent metabolic risk.

Question 49: During a weight management session, a client states, 'I know I should eat better, but I just can't seem to do it.' This reflects which stage of the Transtheoretical Model?

Relapse
Contemplation (Correct answer)
Preparation
Precontemplation

Correct answer: Contemplation

Acknowledging the need for change but feeling unable to act on it reflects the ambivalence characteristic of the Contemplation stage.

Question 50: What role does continuous improvement play in medical nutrition therapy for CDN certified professionals?

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

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

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

Question 51: A renal dietitian assesses a patient's protein-energy wasting (PEW). Which combination of findings best confirms PEW in a dialysis patient?

High BMI and high albumin
Low phosphorus and high potassium
Low serum albumin, unintentional weight loss, and reduced muscle mass (Correct answer)
High BUN and high creatinine

Correct answer: Low serum albumin, unintentional weight loss, and reduced muscle mass

PEW is characterized by low serum albumin, involuntary weight loss, and muscle wasting, reflecting inadequate protein and energy stores in CKD.

Question 52: When a CDN professional encounters an unfamiliar challenge in medical nutrition therapy, what is the recommended first course of action?

Proceed based on personal intuition alone
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

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 53: What is the role of water in metabolism?

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

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

Memorization of all relevant regulations without understanding context
The ability to work independently without any oversight
Reliance on a single methodology for all situations
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 weight management counseling need analytical skills to assess situations, communication skills to convey findings, and ethical judgment to make sound decisions.

Question 55: What is the primary role of intrinsic factor in nutrition?

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

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 56: 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 57: A client's food diary reveals consistent nighttime eating after 9 PM comprising 40% of daily calories. This pattern is most consistent with:

Prader-Willi syndrome
Seasonal affective disorder
Night eating syndrome (NES) (Correct answer)
Reactive hypoglycemia

Correct answer: Night eating syndrome (NES)

Night eating syndrome is characterized by consuming a significant portion of daily calories after the evening meal or during nocturnal awakenings.

Question 58: In the DASH diet for hypertension, what is the recommended daily sodium target?

2,300 mg or lower (Correct answer)
1,000 mg
4,000 mg
3,500 mg

Correct answer: 2,300 mg or lower

The DASH diet targets ≤2,300 mg sodium/day, with further reduction to 1,500 mg for greater blood pressure lowering.

Question 59: Which vitamin is added to milk in the United States primarily to prevent rickets in children?

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

Correct answer: Vitamin D

Vitamin D fortification of cow's milk has been standard in the US since the 1930s and is the primary public health strategy to prevent nutritional rickets.

Question 60: How does the body regulate blood sugar levels?

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

Correct answer: By secreting insulin and glucagon to regulate levels

The body maintains blood sugar homeostasis primarily through the hormones insulin and glucagon, secreted by the pancreas. Insulin lowers high blood sugar by promoting glucose uptake into cells, while glucagon raises low blood sugar by stimulating the liver to release stored glucose, ensuring stable energy supply.

Question 61: In public health nutrition, 'primary prevention' of obesity would include which of the following?

Weight management counseling for overweight adults
Treatment of obesity-related type 2 diabetes
Bariatric surgery referral programs
School-based programs promoting healthy eating before obesity develops (Correct answer)

Correct answer: School-based programs promoting healthy eating before obesity develops

Primary prevention aims to prevent disease onset; school-based healthy eating programs target children before obesity develops.

Question 62: Patients on warfarin (Coumadin) anticoagulation therapy require careful monitoring of their intake of which vitamin?

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

Correct answer: Vitamin K

Vitamin K is essential for the synthesis of clotting factors II, VII, IX, and X; fluctuating intake directly affects warfarin's anticoagulant effect.

Question 63: According to the Americans with Disabilities Act (ADA), a hospital cafeteria must ensure that self-service food bars and salad bars are accessible. Which measurement is the standard maximum reach height for a forward approach?

48 inches (Correct answer)
44 inches
36 inches
54 inches

Correct answer: 48 inches

ADA standards specify that the maximum forward reach height for accessible design is 48 inches (122 cm) to accommodate wheelchair users.

Question 64: During prolonged fasting, which metabolic state predominates to spare muscle protein?

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

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 65: A client with lactose intolerance asks about calcium sources. Which plant-based food provides the most bioavailable calcium?

Fortified soy milk (Correct answer)
Almonds
Beet greens
Spinach

Correct answer: Fortified soy milk

Fortified soy milk provides calcium that is highly bioavailable (absorption ~30%), comparable to cow's milk, unlike spinach and beet greens which contain oxalates that inhibit calcium absorption.

Question 66: 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)
Delegating all responsibilities to junior staff
Minimizing documentation to save time
Completing implementation as quickly as possible regardless of quality

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 67: In a hospital food service, which team member is primarily responsible for completing the nutritional assessment and determining the patient's medical nutrition therapy plan?

Executive chef
Diet technician registered (DTR)
Food service director
Registered dietitian nutritionist (RDN) (Correct answer)

Correct answer: Registered dietitian nutritionist (RDN)

The Registered Dietitian Nutritionist (RDN) holds the professional credential and scope of practice to conduct nutritional assessments and prescribe medical nutrition therapy.

Question 68: Which dietary pattern has the strongest evidence for favorably modifying the epigenome in populations at cardiovascular risk?

Western diet high in processed foods
High-protein carnivore diet
High-fat ketogenic diet
Mediterranean diet rich in polyphenols and olive oil (Correct answer)

Correct answer: Mediterranean diet rich in polyphenols and olive oil

The Mediterranean diet provides polyphenols, folate, and omega-3 fatty acids that support beneficial DNA methylation and histone modification patterns.

Question 69: A Somali refugee patient avoids eating during daytime hours in Ramadan. What is the dietitian's best initial response?

Advise the patient to skip Ramadan fasting for health reasons
Acknowledge the practice and collaboratively adjust meal timing to Suhoor and Iftar (Correct answer)
Refer the patient to a physician before providing any nutrition guidance
Prescribe a high-calorie supplement to compensate for daytime fasting

Correct answer: Acknowledge the practice and collaboratively adjust meal timing to Suhoor and Iftar

Culturally competent care involves respecting religious fasting practices and adapting meal timing to the patient's observance.

Question 70: Which macronutrient is the body's primary source of quick energy?

Fats
Vitamins
Carbohydrates (Correct answer)
Proteins

Correct answer: Carbohydrates

Carbohydrates are the most efficient and preferred source of immediate energy for the body. They are rapidly broken down into glucose, which is then utilized by cells to produce ATP, fueling daily activities and physical exertion.

Question 71: A client with hypothyroidism and obesity reports difficulty losing weight despite adherence to a 1,400 kcal/day diet. The dietitian should FIRST:

Recommend a ketogenic diet to bypass thyroid function
Further reduce calories to 800 kcal/day
Assume the client is underreporting food intake
Verify thyroid medication compliance and current TSH levels with the physician (Correct answer)

Correct answer: Verify thyroid medication compliance and current TSH levels with the physician

Undertreated hypothyroidism significantly reduces metabolic rate; the dietitian should communicate with the physician to ensure thyroid function is optimized before adjusting the diet.

Question 72: The Transtheoretical Model (TTM) stage where a client is actively changing behavior but for less than 6 months is called:

Action (Correct answer)
Contemplation
Preparation
Maintenance

Correct answer: Action

The Action stage involves active behavioral change that has been occurring for less than 6 months.

Question 73: A client with the COMT Val158Met low-activity genotype (Met/Met) may have altered metabolism of which dietary compound?

Catechol-containing polyphenols such as quercetin and EGCG (Correct answer)
Sucrose and fructose
Dietary cholesterol
Saturated fatty acids

Correct answer: Catechol-containing polyphenols such as quercetin and EGCG

COMT methylates and inactivates catechol-structured compounds; the Met/Met variant reduces this activity, prolonging the effects of catechol polyphenols and catecholamines.

Question 74: What is the primary function of carbohydrates in the human body?

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

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 75: A patient on warfarin therapy should be counseled about maintaining consistent intake of which nutrient?

Vitamin D
Vitamin C
Vitamin K (Correct answer)
Vitamin B12

Correct answer: Vitamin K

Vitamin K directly affects warfarin's anticoagulant effect; consistent intake (not elimination) is recommended to maintain stable INR levels.

Question 76: Which metabolic pathway produces ATP in cells?

Lactic acid production
Cellular respiration (Correct answer)
Photosynthesis
Fermentation

Correct answer: Cellular respiration

Cellular respiration is the primary metabolic pathway by which cells break down glucose and other fuel molecules to produce adenosine triphosphate (ATP). ATP is the main energy currency of the cell, powering virtually all cellular activities, from muscle contraction to active transport.

Question 77: In the stepped-care model for eating disorder treatment, which level of care is appropriate for a medically stable patient with moderate symptoms who cannot attend day treatment?

Intensive outpatient program (IOP) (Correct answer)
Inpatient hospitalization
Unstructured self-help only
Residential treatment

Correct answer: Intensive outpatient program (IOP)

IOP (typically 3–5 days/week, 3 hours/day) bridges the gap for medically stable patients who need more support than weekly outpatient therapy.

Question 78: Which behavioral therapy component specifically targets the cycle of restricting → binging → purging in bulimia nervosa?

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

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 79: A patient with nephrotic syndrome presents with significant edema and low serum albumin. What protein recommendation is appropriate?

Normal protein intake (0.8-1.0 g/kg) as high protein increases proteinuria (Correct answer)
Very high protein intake (2.5 g/kg) to replace lost albumin
No dietary protein allowed
Protein restriction below 0.6 g/kg to preserve kidney function

Correct answer: Normal protein intake (0.8-1.0 g/kg) as high protein increases proteinuria

High protein intake worsens proteinuria in nephrotic syndrome; normal intake of 0.8-1.0 g/kg is recommended to avoid accelerating protein losses.

Question 80: During refeeding of a severely malnourished anorexia patient, which electrolyte requires closest monitoring during the first 72 hours?

Magnesium
Sodium
Phosphorus (Correct answer)
Calcium

Correct answer: Phosphorus

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

Question 81: Indirect calorimetry measures energy expenditure by analyzing:

Carbon dioxide production and respiratory quotient (RQ) (Correct answer)
Creatinine clearance from urine
Blood glucose utilization rate
Heat production directly from the body surface

Correct answer: Carbon dioxide production and respiratory quotient (RQ)

Indirect calorimetry measures oxygen consumption (VO₂) and CO₂ production (VCO₂) to calculate resting energy expenditure via the Weir equation and determine the respiratory quotient.

Question 82: Which complication is most associated with rapid advancement of enteral tube feeding in a critically ill patient?

Constipation
Aspiration pneumonia (Correct answer)
Hyponatremia
Hypoglycemia

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 83: A cyclist wants to maximize fat oxidation during training. At what approximate exercise intensity (% VO2 max) does peak fat oxidation (Fatmax) typically occur in trained athletes?

20–30%
85–95%
70–80%
45–65% (Correct answer)

Correct answer: 45–65%

Peak fat oxidation (Fatmax) typically occurs at 45–65% VO2 max in trained endurance athletes, making moderate-intensity exercise optimal for fat burning.

Question 84: A patient post-Roux-en-Y gastric bypass is at highest risk for deficiency in which nutrient due to bypass of the duodenum and proximal jejunum?

Potassium
Vitamin K
Iron (Correct answer)
Vitamin C

Correct answer: Iron

Iron is primarily absorbed in the duodenum and proximal jejunum, which are bypassed in Roux-en-Y gastric bypass, leading to high risk of iron-deficiency anemia.

Question 85: A CKD patient's laboratory shows elevated serum potassium of 6.1 mEq/L. Which food group should be most aggressively restricted?

High-potassium fruits and vegetables like bananas, oranges, and potatoes (Correct answer)
Refined grains and white bread
Lean meats and poultry
Low-fat dairy products

Correct answer: High-potassium fruits and vegetables like bananas, oranges, and potatoes

High-potassium fruits and vegetables are the primary dietary source driving hyperkalemia and must be restricted or replaced in CKD.

Question 86: A hospital food service is transitioning to a cook-chill system. Which is a primary food safety concern with this production method?

Increased water usage during production
Reduction in food variety available
The need for more expensive equipment
Proper rapid chilling to below 41°F within the required timeframe (Correct answer)

Correct answer: Proper rapid chilling to below 41°F within the required timeframe

Cook-chill requires rapid chilling of cooked foods from 135°F to 41°F or below within a defined time window to prevent bacterial growth in the danger zone.

Question 87: Cyclosporine, an immunosuppressant used after organ transplantation, causes wasting of which electrolyte through nephrotoxic effects on the renal tubules?

Phosphorus
Calcium
Potassium
Magnesium (Correct answer)

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 88: What is the recommended eicosapentaenoic acid plus docosahexaenoic acid (EPA+DHA) intake per day for a patient with established coronary heart disease?

500 mg/day
100 mg/day
250 mg/day
1,000 mg/day or more (Correct answer)

Correct answer: 1,000 mg/day or more

AHA recommends at least 1 g/day of EPA+DHA from fish or supplements for patients with documented coronary heart disease.

Question 89: Which MNT goal is the primary focus in the acute phase of pancreatitis?

High-protein oral diet
Immediate parenteral nutrition
Low-fat enteral feeding started within 6 hours
Bowel rest and IV hydration (Correct answer)

Correct answer: Bowel rest and IV hydration

Traditional management of acute pancreatitis begins with bowel rest and IV hydration to reduce pancreatic stimulation.

Question 90: A critically ill patient requires enteral nutrition but has high gastric residual volumes (GRVs). The MOST appropriate next step is to:

Discontinue enteral nutrition immediately
Advance the feeding tube to post-pyloric placement (Correct answer)
Switch to parenteral nutrition
Double the infusion rate to compensate

Correct answer: Advance the feeding tube to post-pyloric placement

Post-pyloric (jejunal) feeding bypasses the stomach and reduces aspiration risk when high GRVs indicate impaired gastric motility.

Question 91: What is the most effective way to measure success in eating disorder treatment within CDN professional practice?

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
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 92: A female marathon runner presents with the female athlete triad. Which combination of findings is most consistent with this condition?

Overtraining syndrome, iron deficiency, high cortisol
High bone density, amenorrhea, high energy availability
Low energy availability, menstrual dysfunction, low bone mineral density (Correct answer)
Amenorrhea, high estrogen, stress fractures

Correct answer: Low energy availability, menstrual dysfunction, low bone mineral density

The female athlete triad consists of low energy availability (with or without disordered eating), menstrual dysfunction, and low bone mineral density.

Question 93: A client on a 1,500 kcal/day plan reports a plateau after 6 weeks despite adherence. Which physiological mechanism most likely explains this?

Accelerated gluconeogenesis increasing caloric intake
Upregulation of uncoupling proteins
Increased leptin sensitivity
Adaptive thermogenesis reducing total energy expenditure (Correct answer)

Correct answer: Adaptive thermogenesis reducing total energy expenditure

Adaptive thermogenesis is a metabolic adaptation where the body reduces energy expenditure in response to caloric restriction, causing weight loss plateaus.

Question 94: What role do vitamins play in metabolism?

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

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 95: A clinical dietitian recommends a 2-gram sodium diet. Which food service practice best supports compliance with this order?

Reducing portion sizes of all foods
Using low-sodium seasoning blends on all patient trays
Providing salt packets on each tray
Flagging the tray ticket and training cooks to use unseasoned preparation methods (Correct answer)

Correct answer: Flagging the tray ticket and training cooks to use unseasoned preparation methods

Flagging tray tickets and training production staff ensures sodium-restricted orders are communicated and followed throughout the food preparation process.

Question 96: What role does continuous improvement play in cultural competency in nutrition for CDN certified professionals?

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
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 cultural competency in nutrition, involving regular evaluation, feedback integration, and process enhancement to maintain high standards.

Question 97: Which metabolic pathway produces ATP in cells?

Lactic acid production
Cellular respiration (Correct answer)
Photosynthesis
Fermentation

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 98: What role does continuous improvement play in nutritional genomics & precision for CDN certified professionals?

It drives ongoing enhancement of practices, processes, and outcomes through systematic evaluation (Correct answer)
It applies only to new professionals in their first year
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 nutritional genomics & precision, involving regular evaluation, feedback integration, and process enhancement to maintain high standards.

Question 99: Which assessment method most accurately measures total body fat percentage in a clinical setting?

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

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 100: Which macronutrient timing strategy most effectively enhances muscle protein synthesis (MPS) after resistance training?

Protein intake only at breakfast regardless of training time
20–40g high-quality protein within 2 hours post-training (Correct answer)
Fat intake >30% of calories immediately post-training
Carbohydrate loading 3 hours before training

Correct answer: 20–40g high-quality protein within 2 hours post-training

Consuming 20–40g of high-quality protein within 2 hours post-resistance training optimally stimulates muscle protein synthesis by maximizing leucine-triggered mTOR signaling.

Question 101: What is 'health literacy' and why is it especially relevant in cross-cultural nutrition counseling?

The ability to cook nutritious meals from scratch
The capacity to obtain, process, and understand basic health information to make appropriate decisions (Correct answer)
Familiarity with government dietary guidelines
Knowledge of medical terminology used in clinical settings

Correct answer: The capacity to obtain, process, and understand basic health information to make appropriate decisions

Health literacy affects a patient's ability to understand and act on nutrition advice, and may vary significantly across cultural and educational backgrounds.

Question 102: How does health and safety regulations affect food service operations?

They don’t have much impact
They ensure food safety and compliance (Correct answer)
They slow down operations
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 103: A 70 kg male athlete uses a 5-day creatine loading protocol (20g/day). After loading, what is the recommended maintenance dose?

0.5g/kg/day
10g/day
15g every other day
3–5g/day (Correct answer)

Correct answer: 3–5g/day

After a loading phase of 20g/day for 5–7 days, 3–5g/day of creatine monohydrate is sufficient to maintain saturated muscle creatine stores.

Question 104: 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
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 105: What is a common challenge in addressing nutrition in low-income communities?

Abundant food availability
Perfect nutrition education
Limited access to nutritious foods (Correct answer)
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 106: What is the role of staff training in food service management?

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

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 107: Which of the following behaviors by a dietitian MOST undermines cultural competency in practice?

Asking a patient about their traditional food practices during assessment
Adapting dietary recommendations to fit a patient's cultural food preferences
Assuming all members of an ethnic group share identical dietary habits (Correct answer)
Using professional interpreters when working with limited-English-proficient patients

Correct answer: Assuming all members of an ethnic group share identical dietary habits

Stereotyping all members of an ethnic group as having the same dietary practices ignores individual variation and undermines culturally competent care.

Question 108: Which inventory management method is most appropriate for a hospital food service to minimize waste with perishable items?

Random rotation based on convenience
FEFO (First Expired, First Out) (Correct answer)
LIFO (Last In, First Out)
FIFO (First In, First Out)

Correct answer: FEFO (First Expired, First Out)

FEFO (First Expired, First Out) is most appropriate for perishables as it ensures items closest to expiration are used first, regardless of when they were received.

Question 109: Which amino acid is considered conditionally essential and is commonly added to PN formulations for critically ill or surgical patients?

Leucine
Methionine
Glutamine (Correct answer)
Arginine

Correct answer: Glutamine

Glutamine becomes conditionally essential during critical illness and surgery, as it is rapidly depleted and supports gut integrity and immune function.

Question 110: A dietitian evaluating a community intervention uses the RE-AIM framework. The 'R' in RE-AIM stands for:

Reach (Correct answer)
Resources
Reliability
Replication

Correct answer: Reach

In the RE-AIM framework, 'R' stands for Reach — the proportion and representativeness of the target population that participates.

Question 111: A patient with chronic kidney disease develops metabolic acidosis. What dietary intervention helps buffer acid load?

Restrict phosphorus further
Increase fruit and vegetable intake (with potassium monitoring) (Correct answer)
Reduce water intake
Increase dietary protein

Correct answer: Increase fruit and vegetable intake (with potassium monitoring)

Fruits and vegetables provide bicarbonate precursors that buffer metabolic acidosis in CKD, though potassium must be monitored carefully.

Question 112: Prealbumin (transthyretin) has a half-life of approximately 2–3 days, making it useful for monitoring:

Adequacy of long-term dietary protein intake
Vitamin A status
Short-term response to nutrition intervention (Correct answer)
Chronic malnutrition over months

Correct answer: Short-term response to nutrition intervention

The short half-life of prealbumin (~2–3 days) makes it a sensitive marker of acute changes in nutritional status and a useful tool for monitoring short-term nutrition therapy response.

Question 113: For a patient with high gastric residual volumes on tube feeds, what feeding strategy is most appropriate?

Switch to post-pyloric (jejunal) feeding (Correct answer)
Add fiber to the formula
Discontinue enteral nutrition
Increase the rate of gastric feeding

Correct answer: Switch to post-pyloric (jejunal) feeding

Post-pyloric feeding bypasses the stomach, reducing aspiration risk in patients with delayed gastric emptying and high residual volumes.

Question 114: Loop diuretics (e.g., furosemide) and thiazide diuretics frequently cause depletion of which electrolyte, potentially leading to cardiac arrhythmias?

Potassium (Correct answer)
Bicarbonate
Chloride
Sodium

Correct answer: Potassium

Both loop and thiazide diuretics increase renal potassium excretion, causing hypokalemia which can precipitate life-threatening cardiac arrhythmias.

Question 115: A dietitian is counseling an older adult on calcium intake. Which combination of factors most impairs calcium absorption?

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

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 116: Iodine is added to table salt in the U.S. primarily to prevent:

Anemia
Scurvy
Goiter and cretinism (Correct answer)
Rickets

Correct answer: Goiter and cretinism

Iodized salt was introduced to prevent iodine deficiency disorders including goiter and cretinism (severe developmental delay in infants).

Question 117: Patients prescribed lithium for bipolar disorder require which specific dietary modification to prevent toxicity, since lithium and this nutrient share renal reabsorption mechanisms?

Low-carbohydrate diet
High-protein diet
Consistent sodium intake (Correct answer)
Low-fat diet

Correct answer: Consistent sodium intake

Sodium and lithium are reabsorbed by the same renal tubular mechanism; sodium depletion (from low-sodium diets or diuretics) causes compensatory lithium retention, increasing toxicity risk.

Question 118: Which mineral is a structural component of thyroid hormones T3 and T4?

Iodine (Correct answer)
Fluoride
Selenium
Chromium

Correct answer: Iodine

Iodine is directly incorporated into the thyroid hormones triiodothyronine (T3) and thyroxine (T4), which regulate metabolic rate.

Question 119: Which behavioral strategy is MOST effective for long-term weight maintenance according to the National Weight Control Registry data?

High-protein cycling diets
Periodic fasting cycles
Calorie banking on weekends
Consistent meal timing and frequent self-monitoring (Correct answer)

Correct answer: Consistent meal timing and frequent self-monitoring

NWCR data consistently show that successful maintainers self-monitor weight and food intake regularly and maintain consistent eating patterns.

Question 120: When working with a male patient with an eating disorder, which clinician consideration is most important?

Males require higher caloric restoration targets than females
Males respond better to pharmacotherapy than psychotherapy
Males exclusively present with muscle dysmorphia
Males are less likely to engage with treatment due to under-recognition and stigma (Correct answer)

Correct answer: Males are less likely to engage with treatment due to under-recognition and stigma

Eating disorders in males are frequently under-recognized and stigmatized, leading to delayed diagnosis and treatment-seeking.

Question 121: A food service operation serves 500 meals/day. If the direct labor cost is $1,850/day, what is the labor cost per meal?

$4.70
$2.70
$5.70
$3.70 (Correct answer)

Correct answer: $3.70

Labor cost per meal = $1,850 ÷ 500 meals = $3.70 per meal.

Question 122: A dietitian is counseling a client with binge eating disorder (BED) and obesity. Which approach should be prioritized initially?

High-intensity interval training program
Prescribing a very-low-calorie diet (VLCD)
Immediate caloric restriction to 1,200 kcal/day
Addressing the eating disorder before focusing on weight loss (Correct answer)

Correct answer: Addressing the eating disorder before focusing on weight loss

Restrictive dieting can exacerbate BED; the eating disorder should be addressed first to establish a healthy relationship with food.

Question 123: In treating binge eating disorder (BED), which pharmacological agent is FDA-approved and works by reducing binge frequency?

Olanzapine
Sertraline
Topiramate
Lisdexamfetamine (Correct answer)

Correct answer: Lisdexamfetamine

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

Question 124: The National School Lunch Program (NSLP) requires participating schools to offer meals that align with:

Academy of Nutrition and Dietetics recommendations
USDA MyPlate portion sizes exclusively
Dietary Guidelines for Americans (Correct answer)
American Heart Association guidelines

Correct answer: Dietary Guidelines for Americans

NSLP meals must meet nutrition standards based on the Dietary Guidelines for Americans, as mandated by USDA.

Question 125: How do lipids contribute to metabolism?

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

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.

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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