CDN Clinical Nutrition & Assessment 3 — Questions and Answers
Question 1: 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
- Switch to parenteral nutrition
- Advance the feeding tube to post-pyloric placement (Correct answer)
- 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 2: Prealbumin (transthyretin) has a half-life of approximately 2–3 days, making it useful for monitoring:
- Chronic malnutrition over months
- Adequacy of long-term dietary protein intake
- Short-term response to nutrition intervention (Correct answer)
- Vitamin A status
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 3: A patient with celiac disease must avoid gluten. Which of the following grains is inherently gluten-free and safe to consume?
- Barley
- Triticale
- Buckwheat (Correct answer)
- Rye
Correct answer: Buckwheat
Buckwheat is botanically unrelated to wheat and is naturally gluten-free, unlike barley, rye, and triticale, which all contain gluten proteins.
Question 4: In nutrition support, which condition is a primary contraindication for enteral nutrition?
- Severe dysphagia
- Prolonged NPO status
- Complete mechanical bowel obstruction (Correct answer)
- Short bowel syndrome
Correct answer: Complete mechanical bowel obstruction
Complete mechanical bowel obstruction prevents normal intestinal transit, making enteral feeding unsafe and parenteral nutrition the appropriate alternative.
Question 5: Refeeding syndrome is primarily caused by a rapid shift of which electrolyte into cells upon reintroduction of carbohydrates?
- Sodium
- Calcium
- Phosphorus (Correct answer)
- Magnesium
Correct answer: Phosphorus
Carbohydrate reintroduction stimulates insulin release, driving phosphate into cells for ATP synthesis, causing a dangerous drop in serum phosphate (hypophosphatemia) characteristic of refeeding syndrome.
Question 6: When conducting a diet history using the food frequency questionnaire (FFQ), a key limitation compared to the 24-hour recall is:
- It cannot estimate portion sizes at all
- It relies heavily on long-term memory and may overestimate intake (Correct answer)
- It is more expensive and time-consuming to administer
- It only captures intake over the past 24 hours
Correct answer: It relies heavily on long-term memory and may overestimate intake
FFQs rely on the respondent's memory of habitual intake over weeks or months, which is subject to recall bias and tends to overestimate consumption compared to prospective methods.
Question 7: Which serum protein is considered the LEAST reliable marker of nutritional status in a patient with acute inflammation or infection?
- Albumin
- Prealbumin
- Transferrin
- All of the above are unreliable in acute inflammation (Correct answer)
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.
CDN Clinical Nutrition & Assessment 3
A critically ill patient requires enteral nutrition but has high gastric residual volumes (GRVs).
The MOST appropriate next step is to: