CN Clinical Procedures & Protocols 2 — Questions and Answers
Question 1: During a nutrition-focused physical exam, temporal wasting and loss of subcutaneous fat at the triceps most directly support a diagnosis of what condition?
- Malnutrition (Correct answer)
- Dehydration
- Vitamin C deficiency
- Fluid overload
Correct answer: Malnutrition
Muscle wasting and subcutaneous fat loss are core physical criteria for diagnosing malnutrition under ASPEN/AND guidelines.
Question 2: A patient beginning enteral nutrition after prolonged starvation develops hypophosphatemia on day 2. What protocol-driven step should have been taken to prevent this?
- Start feeds at a reduced rate with electrolyte monitoring and thiamine (Correct answer)
- Begin full-rate feeds with extra protein
- Restrict all fluids for 48 hours
- Give a bolus of dextrose before feeding
Correct answer: Start feeds at a reduced rate with electrolyte monitoring and thiamine
Refeeding syndrome prevention requires slow initiation of nutrition, thiamine supplementation, and close electrolyte monitoring and repletion.
Question 3: Which measurement is required to calculate a patient's body mass index during a clinical nutrition assessment?
- Height and weight (Correct answer)
- Waist circumference and age
- Triceps skinfold and arm span
- Weight and wrist circumference
Correct answer: Height and weight
BMI is calculated as weight in kilograms divided by height in meters squared.
Question 4: Before starting a tube feeding through a newly placed nasogastric tube, the gold-standard method to confirm tube placement is:
- Radiographic (X-ray) confirmation (Correct answer)
- Auscultating air insufflation over the stomach
- Checking pH of oral secretions
- Observing the patient for coughing
Correct answer: Radiographic (X-ray) confirmation
X-ray visualization of the tube tip is the gold standard for confirming nasogastric tube placement before feeding.
Question 5: A nutritionist measuring mid-upper arm circumference (MUAC) should position the tape at which anatomical location?
- Midpoint between the acromion process and olecranon process (Correct answer)
- Two inches above the elbow crease
- Widest point of the forearm
- Directly over the deltoid insertion
Correct answer: Midpoint between the acromion process and olecranon process
MUAC is measured at the midpoint between the acromion (shoulder) and olecranon (elbow) landmarks on a relaxed arm.
Question 6: In a 24-hour dietary recall, using a multiple-pass method primarily serves to:
- Improve completeness and accuracy of reported intake (Correct answer)
- Shorten the interview time
- Calculate resting energy expenditure
- Verify laboratory values
Correct answer: Improve completeness and accuracy of reported intake
The multiple-pass technique systematically probes for forgotten foods and portion details, improving recall accuracy.
Question 7: Which laboratory value is considered a negative acute-phase reactant and falls during inflammation, limiting its use as a pure marker of protein status?
- Albumin (Correct answer)
- C-reactive protein
- Hemoglobin A1c
- Ferritin
Correct answer: Albumin
Albumin decreases with inflammation regardless of nutritional intake, so it cannot reliably reflect protein status alone.
CN Clinical Procedures & Protocols 2
During a nutrition-focused physical exam, temporal wasting and loss of subcutaneous fat at the triceps most directly support a diagnosis of what condition?