CDN Clinical Nutrition & Assessment 2 — Questions and Answers
Question 1: A patient with chronic kidney disease (CKD) stage 4 presents with hyperkalemia. Which dietary intervention is the priority?
- Restrict sodium to <2g/day
- Limit potassium to 2000–3000 mg/day (Correct answer)
- Increase phosphorus intake
- Restrict fluid to 500 mL/day
Correct answer: Limit potassium to 2000–3000 mg/day
Hyperkalemia in CKD requires potassium restriction, typically 2000–3000 mg/day, to prevent life-threatening cardiac arrhythmias.
Question 2: Which anthropometric measurement best reflects visceral adiposity and associated metabolic risk in adults?
- Body mass index (BMI)
- Waist circumference (Correct answer)
- Mid-upper arm circumference
- Triceps skinfold thickness
Correct answer: Waist circumference
Waist circumference is the best anthropometric proxy for visceral adiposity and correlates most strongly with cardiometabolic risk.
Question 3: A registered dietitian reviews a patient's 24-hour recall showing a diet very high in oxalate-rich foods. This finding is most clinically significant for a patient with a history of:
- Struvite kidney stones
- Calcium oxalate kidney stones (Correct answer)
- Uric acid kidney stones
- Cystine kidney stones
Correct answer: Calcium oxalate kidney stones
High dietary oxalate increases urinary oxalate excretion, promoting calcium oxalate crystal formation and recurrent calcium oxalate nephrolithiasis.
Question 4: The Mifflin-St Jeor equation is used clinically to estimate:
- Thermic effect of food
- Resting metabolic rate (Correct answer)
- Total daily energy expenditure
- Physical activity level
Correct answer: Resting metabolic rate
The Mifflin-St Jeor equation estimates resting metabolic rate (RMR) using age, sex, height, and weight, and is considered the most accurate predictive equation in non-obese adults.
Question 5: 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?
- Vitamin C
- Iron (Correct answer)
- Vitamin K
- Potassium
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 6: Which lab value is the most reliable indicator of long-term glycemic control over the previous 2–3 months?
- Fasting plasma glucose
- Hemoglobin A1c (HbA1c) (Correct answer)
- Postprandial glucose
- Fructosamine
Correct answer: Hemoglobin A1c (HbA1c)
HbA1c reflects the percentage of glycated hemoglobin accumulated over the lifespan of red blood cells (~120 days), making it the gold standard for long-term glycemic assessment.
Question 7: During a nutrition-focused physical exam (NFPE), which finding is most indicative of zinc deficiency?
- Bitot's spots on the conjunctiva
- Acrodermatitis enteropathica-like rash and alopecia (Correct answer)
- Bleeding gums
- Peripheral edema
Correct answer: Acrodermatitis enteropathica-like rash and alopecia
Zinc deficiency classically presents with a perioral/acral dermatitis rash, alopecia, impaired wound healing, and altered taste and smell.
CDN Clinical Nutrition & Assessment 2
A patient with chronic kidney disease (CKD) stage 4 presents with hyperkalemia.
Which dietary intervention is the priority?