RDN Medical Nutrition Therapy 2 — Questions and Answers
Question 1: A patient with chronic kidney disease (CKD) stage 4 who is not on dialysis should have their dietary protein intake restricted to approximately:
- 0.8 g/kg/day
- 0.6–0.8 g/kg/day (Correct answer)
- 1.2 g/kg/day
- 1.5 g/kg/day
Correct answer: 0.6–0.8 g/kg/day
For non-dialysis CKD patients, protein restriction of 0.6–0.8 g/kg/day helps slow progression and reduce uremic symptoms.
Question 2: Which of the following lab values is most indicative of long-term glycemic control in a patient with type 2 diabetes?
- Fasting blood glucose
- Postprandial glucose
- Hemoglobin A1c (HbA1c) (Correct answer)
- C-peptide level
Correct answer: Hemoglobin A1c (HbA1c)
HbA1c reflects average blood glucose over the preceding 2–3 months and is the gold standard for monitoring long-term glycemic control.
Question 3: A patient post-Roux-en-Y gastric bypass is at highest risk for deficiency of which nutrient due to bypass of the primary absorption site?
- Vitamin C
- Iron (Correct answer)
- Vitamin D
- Selenium
Correct answer: Iron
Iron is primarily absorbed in the duodenum and proximal jejunum, which are bypassed in RYGB, placing patients at high risk for iron deficiency anemia.
Question 4: For a patient with acute pancreatitis who can tolerate oral intake, the preferred feeding approach is:
- NPO until amylase and lipase normalize
- Low-fat oral diet as tolerated (Correct answer)
- High-protein parenteral nutrition
- Elemental formula via nasogastric tube only
Correct answer: Low-fat oral diet as tolerated
Current evidence supports initiating a low-fat oral diet as tolerated in mild acute pancreatitis rather than prolonged NPO status.
Question 5: Which dietary modification is the primary MNT recommendation for a patient newly diagnosed with nephrotic syndrome?
- High-protein diet to compensate for urinary losses
- Sodium restriction to manage edema (Correct answer)
- Fluid restriction below 1 L/day
- High-fat diet to provide energy
Correct answer: Sodium restriction to manage edema
Sodium restriction is the primary MNT goal in nephrotic syndrome to manage edema and hypertension, while excessive protein supplementation is no longer recommended.
Question 6: A patient on warfarin therapy asks about vitamin K intake. The best dietary counseling advice is to:
- Eliminate all vitamin K-containing foods
- Maintain a consistent daily intake of vitamin K-rich foods (Correct answer)
- Increase vitamin K to counteract warfarin
- Avoid all green vegetables permanently
Correct answer: Maintain a consistent daily intake of vitamin K-rich foods
Consistency in vitamin K intake allows stable INR management; sudden increases or decreases can destabilize anticoagulation therapy.
Question 7: In a patient with cirrhosis, which MNT strategy helps prevent hepatic encephalopathy while maintaining adequate nutrition?
- Restrict protein to 0.5 g/kg/day
- Provide adequate protein (1.2–1.5 g/kg/day) with branched-chain amino acids if needed (Correct answer)
- Eliminate all aromatic amino acids
- Use only enteral nutrition, never oral
Correct answer: Provide adequate protein (1.2–1.5 g/kg/day) with branched-chain amino acids if needed
Current guidelines recommend 1.2–1.5 g protein/kg/day for cirrhosis; protein restriction is no longer advised as it worsens outcomes, and BCAA supplementation may help refractory encephalopathy.
RDN Medical Nutrition Therapy 2
A patient with chronic kidney disease (CKD) stage 4 who is not on dialysis should have their dietary protein intake restricted to approximately: