RDN Medical Nutrition Therapy 3 — Questions and Answers
Question 1: A patient with heart failure is prescribed a fluid restriction of 1.5 L/day. Which food item is most important to count toward this fluid allotment?
- Dry crackers
- Gelatin desserts (Correct answer)
- Bread
- Cheese
Correct answer: Gelatin desserts
Foods that are liquid at room temperature, including gelatin, ice cream, and soups, must be counted in fluid restriction for heart failure patients.
Question 2: Which carbohydrate counting approach is recommended for patients with type 1 diabetes using intensive insulin therapy?
- Fixed carbohydrate at every meal regardless of insulin
- Carbohydrate-to-insulin ratio adjusted based on grams consumed (Correct answer)
- Limiting carbohydrate to under 20 g per day
- Only consuming low-glycemic index foods with no counting needed
Correct answer: Carbohydrate-to-insulin ratio adjusted based on grams consumed
Patients on intensive insulin therapy use an individualized carbohydrate-to-insulin ratio to match insulin doses to actual carbohydrate intake, providing flexibility and better glycemic control.
Question 3: A celiac disease patient reports persistent symptoms despite following a gluten-free diet. The FIRST step in MNT assessment should be:
- Prescribe elemental formula
- Conduct a thorough dietary history to identify hidden gluten sources (Correct answer)
- Initiate corticosteroid therapy
- Switch to a low-FODMAP diet immediately
Correct answer: Conduct a thorough dietary history to identify hidden gluten sources
A detailed dietary history is essential to identify inadvertent gluten exposure from cross-contamination or hidden sources before considering other interventions.
Question 4: In HIV/AIDS patients with wasting syndrome, which combination of MNT strategies is most appropriate?
- Low-protein, high-fat diet with vitamin supplements
- High-calorie, high-protein diet with micronutrient optimization (Correct answer)
- Carbohydrate restriction to improve CD4 count
- Fluid restriction and sodium supplementation
Correct answer: High-calorie, high-protein diet with micronutrient optimization
HIV wasting requires aggressive nutrition support with high calorie and protein intake alongside micronutrient repletion to preserve lean body mass and immune function.
Question 5: For a patient with Crohn's disease in remission, which dietary approach has the strongest evidence for maintaining remission?
- Strict low-residue diet indefinitely
- Exclusive enteral nutrition
- Individualized diet based on food tolerance with adequate fiber (Correct answer)
- Gluten-free diet regardless of celiac status
Correct answer: Individualized diet based on food tolerance with adequate fiber
Individualized dietary approaches based on tolerance, with adequate fiber intake and avoidance of personal trigger foods, are recommended for maintaining remission in Crohn's disease.
Question 6: A 68-year-old woman with osteoporosis and vitamin D deficiency is recommended a daily calcium intake of 1,200 mg. She consumes 600 mg from food. How much supplemental calcium is needed, and what form is preferred if she takes omeprazole?
- 600 mg as calcium carbonate
- 600 mg as calcium citrate (Correct answer)
- 1,200 mg as calcium carbonate
- No supplement needed if dairy is included
Correct answer: 600 mg as calcium citrate
Calcium citrate does not require stomach acid for absorption, making it preferable for patients on acid-suppressing medications like proton pump inhibitors.
Question 7: Which indicator is most useful for monitoring adequacy of MNT in a patient receiving long-term home parenteral nutrition (HPN)?
- Body weight alone
- Weekly prealbumin levels
- Regular assessment of functional status, weight, labs, and trace minerals (Correct answer)
- Daily urine output
Correct answer: Regular assessment of functional status, weight, labs, and trace minerals
Monitoring HPN adequacy requires a comprehensive approach including functional status, weight trends, metabolic labs, and trace mineral levels to detect deficiencies and complications.
RDN Medical Nutrition Therapy 3
A patient with heart failure is prescribed a fluid restriction of 1.5 L/day.
Which food item is most important to count toward this fluid allotment?