ISSA Risk Assessment & Mitigation 3 — Questions and Answers
Question 1: A client reports taking 10,000 IU of vitamin D daily without medical supervision. What is the primary risk the nutritionist should communicate?
- Vitamin D toxicity leading to hypercalcemia (Correct answer)
- Increased risk of vitamin K deficiency
- Reduced sun exposure sensitivity
- Suppression of vitamin A absorption
Correct answer: Vitamin D toxicity leading to hypercalcemia
Chronic high-dose vitamin D supplementation can cause hypercalcemia, leading to nausea, kidney damage, and cardiovascular complications.
Question 2: Which scenario most clearly indicates a conflict of interest risk in a nutritionist-client relationship?
- Recommending a specific brand of protein powder from which the nutritionist earns commissions without disclosing this (Correct answer)
- Suggesting a client drink more water to meet hydration goals
- Recommending a government-endorsed food guide
- Advising a client to increase vegetable intake
Correct answer: Recommending a specific brand of protein powder from which the nutritionist earns commissions without disclosing this
Recommending products for personal financial gain without disclosure constitutes an undisclosed conflict of interest and breaches ethical standards.
Question 3: What is the most appropriate action when a client's self-reported symptoms suggest orthorexia nervosa?
- Design a stricter clean-eating protocol to satisfy the client's goals
- Refer the client to a mental health professional specializing in eating disorders (Correct answer)
- Provide a broader variety meal plan and monitor for 30 days
- Educate the client on macronutrient flexibility and continue sessions
Correct answer: Refer the client to a mental health professional specializing in eating disorders
Orthorexia is an eating disorder requiring psychological intervention beyond the ISSA nutritionist's scope of practice.
Question 4: Which blood biomarker, if elevated, would indicate the highest risk concern when a client is following a high saturated fat ketogenic diet?
- Elevated serum calcium
- Elevated LDL cholesterol, particularly small dense LDL particles (Correct answer)
- Elevated serum potassium
- Elevated serum sodium
Correct answer: Elevated LDL cholesterol, particularly small dense LDL particles
Elevated small dense LDL particles are strongly associated with increased atherosclerotic cardiovascular disease risk, which must be monitored on high saturated fat diets.
Question 5: A pregnant client asks about mercury exposure from fish consumption. Which fish poses the HIGHEST risk and should be avoided?
- Salmon
- Sardines
- Swordfish (Correct answer)
- Tilapia
Correct answer: Swordfish
Swordfish is a large predatory fish that bioaccumulates the highest levels of methylmercury, posing significant neurotoxicity risk to fetal development.
Question 6: What is the most significant risk of recommending very high doses of iron supplementation to a male client who has not been diagnosed with iron deficiency?
- Reduced zinc absorption and iron overload toxicity (Correct answer)
- Temporary increases in energy levels
- Mild improvement in aerobic capacity
- Decreased risk of anemia
Correct answer: Reduced zinc absorption and iron overload toxicity
Excess iron supplementation in males without diagnosed deficiency can cause iron overload (hemochromatosis risk), oxidative stress, and inhibit zinc absorption.
Question 7: Under the ISSA framework, which of the following represents the correct escalation pathway when a client discloses an eating disorder history?
- Continue the nutrition program but avoid discussing food restriction
- Document the disclosure, pause intensive dietary programming, and coordinate with the client's treatment team (Correct answer)
- Proceed normally since the disorder is historical and no longer active
- Refer the client to a different nutritionist
Correct answer: Document the disclosure, pause intensive dietary programming, and coordinate with the client's treatment team
A history of eating disorders requires coordinated care with the client's treatment team before implementing dietary changes, to avoid triggering relapse.
ISSA Risk Assessment & Mitigation 3
A client reports taking 10,000 IU of vitamin D daily without medical supervision.
What is the primary risk the nutritionist should communicate?