RDN Clinical Nutrition 3 — Questions and Answers
Question 1: A patient with liver cirrhosis and hepatic encephalopathy is being assessed for nutrition support. Which dietary approach is currently recommended?
- Protein restriction to 0.6 g/kg/day to reduce ammonia
- Normal-to-high protein intake (1.2–1.5 g/kg/day) with branched-chain amino acids if needed (Correct answer)
- High-fat, low-carbohydrate diet to spare protein
- NPO with total parenteral nutrition only
Correct answer: Normal-to-high protein intake (1.2–1.5 g/kg/day) with branched-chain amino acids if needed
Current evidence supports adequate protein intake (1.2–1.5 g/kg/day) in cirrhosis; protein restriction worsens sarcopenia and outcomes without reliably reducing encephalopathy.
Question 2: Which vitamin deficiency is most commonly associated with Wernicke's encephalopathy in hospitalized patients?
- Vitamin B12 (cobalamin)
- Thiamine (vitamin B1) (Correct answer)
- Niacin (vitamin B3)
- Pyridoxine (vitamin B6)
Correct answer: Thiamine (vitamin B1)
Wernicke's encephalopathy results from acute thiamine deficiency, causing the classic triad of confusion, ophthalmoplegia, and ataxia.
Question 3: A patient undergoing chemotherapy develops severe mucositis and cannot meet oral intake goals. What is the preferred route of nutrition support?
- Total parenteral nutrition (TPN) via central line
- Nasogastric enteral tube feeding (Correct answer)
- Peripheral parenteral nutrition
- Gastrostomy tube feeding
Correct answer: Nasogastric enteral tube feeding
Enteral nutrition via nasogastric tube is preferred over parenteral nutrition when the GI tract is functional, as it preserves gut integrity and reduces infection risk.
Question 4: In type 2 diabetes management, which dietary pattern has the strongest evidence for improving glycemic control and reducing HbA1c?
- Low-fat, high-carbohydrate diet
- Low-carbohydrate diet (<130 g/day) (Correct answer)
- High-protein diet (>35% calories)
- Intermittent fasting only
Correct answer: Low-carbohydrate diet (<130 g/day)
Multiple RCTs demonstrate that low-carbohydrate diets produce the greatest reductions in HbA1c and postprandial glucose excursions in type 2 diabetes.
Question 5: What is the primary concern when initiating enteral nutrition in a patient with acute pancreatitis?
- Enteral feeding stimulates pancreatic secretion and worsens inflammation (Correct answer)
- Jejunal feeding is less safe than gastric feeding in pancreatitis
- Early enteral nutrition increases mortality in acute pancreatitis
- Starting EN within 48 hours is contraindicated per current guidelines
Correct answer: Enteral feeding stimulates pancreatic secretion and worsens inflammation
While pancreatic stimulation was the historical concern, current evidence supports early jejunal EN as safe because distal feeding minimizes cephalic and gastric phases of pancreatic stimulation.
Question 6: A 70-year-old patient with COPD and cachexia needs nutrition support. Which caloric and protein goal is most appropriate?
- 25–30 kcal/kg/day and 1.2–1.5 g protein/kg/day (Correct answer)
- 15–20 kcal/kg/day and 0.8 g protein/kg/day
- 35–45 kcal/kg/day and 2.5 g protein/kg/day
- 20 kcal/kg/day and 0.6 g protein/kg/day
Correct answer: 25–30 kcal/kg/day and 1.2–1.5 g protein/kg/day
COPD patients with cachexia require moderate energy (25–30 kcal/kg) and higher protein (1.2–1.5 g/kg) to support respiratory muscle function and minimize catabolism.
Question 7: Which electrolyte abnormality is a hallmark finding in patients receiving aggressive diuretic therapy who develop metabolic alkalosis?
- Hypernatremia
- Hyperkalemia
- Hypokalemia (Correct answer)
- Hyperphosphatemia
Correct answer: Hypokalemia
Loop and thiazide diuretics cause urinary potassium wasting, leading to hypokalemia which promotes metabolic alkalosis through increased renal bicarbonate reabsorption.
RDN Clinical Nutrition 3
A patient with liver cirrhosis and hepatic encephalopathy is being assessed for nutrition support.
Which dietary approach is currently recommended?