Clinical Nutritionist CCN Clinical Nutritionist CCN MCQ 2 — Questions and Answers
Question 1: A patient with chronic kidney disease (CKD) stage 4 asks about protein intake. Which recommendation is most appropriate?
- 1.5 g/kg/day to preserve muscle mass
- 0.6–0.8 g/kg/day to slow disease progression (Correct answer)
- 2.0 g/kg/day to compensate for urinary losses
- Unrestricted protein because dialysis is not yet needed
Correct answer: 0.6–0.8 g/kg/day to slow disease progression
For pre-dialysis CKD, a low-protein diet of 0.6–0.8 g/kg/day helps reduce uremic toxin accumulation and slows disease progression.
Question 2: Which fatty acid is the primary precursor for prostaglandin E2 (PGE2), a pro-inflammatory eicosanoid?
- Alpha-linolenic acid (ALA)
- Eicosapentaenoic acid (EPA)
- Arachidonic acid (AA) (Correct answer)
- Docosahexaenoic acid (DHA)
Correct answer: Arachidonic acid (AA)
Arachidonic acid, an omega-6 fatty acid, is the direct precursor for the 2-series prostaglandins, including pro-inflammatory PGE2.
Question 3: A 58-year-old woman taking warfarin wants to increase her intake of leafy greens. What is the best clinical nutritionist guidance?
- Eliminate all leafy greens to prevent clotting risk
- Maintain a consistent, moderate intake of vitamin K-rich foods daily (Correct answer)
- Supplement with vitamin K2 to offset dietary vitamin K1
- Eat leafy greens only on days she skips warfarin
Correct answer: Maintain a consistent, moderate intake of vitamin K-rich foods daily
Consistency in vitamin K intake allows the prescriber to stabilize the warfarin dose; drastic fluctuations, not moderate steady intake, destabilize INR.
Question 4: Which laboratory marker best reflects long-term glycemic control over approximately 3 months?
- Fasting plasma glucose
- Postprandial glucose at 2 hours
- Glycated hemoglobin (HbA1c) (Correct answer)
- Fructosamine
Correct answer: Glycated hemoglobin (HbA1c)
HbA1c reflects average blood glucose over the 90-day lifespan of red blood cells and is the gold standard for long-term glycemic monitoring.
Question 5: A client presents with fatigue, glossitis, and megaloblastic anemia. Serum B12 is normal but methylmalonic acid (MMA) is elevated. What is the most likely diagnosis?
- Iron deficiency anemia
- Functional vitamin B12 deficiency (Correct answer)
- Folate deficiency anemia
- Vitamin B6 deficiency
Correct answer: Functional vitamin B12 deficiency
Elevated MMA with normal serum B12 indicates functional B12 deficiency, where B12 is present in blood but not adequately utilized at the cellular level.
Question 6: In the context of the glycemic index (GI), which factor most significantly lowers the GI of a carbohydrate food?
- Increasing sugar content
- Adding dietary fiber (Correct answer)
- Removing the food's skin or bran
- Cooking starch until fully gelatinized
Correct answer: Adding dietary fiber
Dietary fiber slows gastric emptying and glucose absorption, reducing the glycemic response and thereby lowering the effective GI of a food.
Question 7: Which vitamin is required as a cofactor for the conversion of homocysteine to methionine?
- Vitamin B6
- Vitamin B12 (Correct answer)
- Vitamin B2
- Vitamin B3
Correct answer: Vitamin B12
Vitamin B12 (as methylcobalamin) is the cofactor for methionine synthase, which remethylates homocysteine to methionine using a methyl group from 5-methyltetrahydrofolate.
Clinical Nutritionist CCN Clinical Nutritionist CCN MCQ 2
A patient with chronic kidney disease (CKD) stage 4 asks about protein intake.
Which recommendation is most appropriate?