Registered Dietitian Nutritionist Registered Dietitian Problem 2 — Questions and Answers
Question 1: A client with chronic kidney disease (CKD) stage 4 asks about protein intake. Which recommendation is most appropriate?
- 1.2–1.5 g/kg/day to preserve muscle mass
- 0.6–0.8 g/kg/day to reduce uremic toxin load (Correct answer)
- 2.0 g/kg/day to compensate for losses
- Protein intake is irrelevant in CKD stage 4
Correct answer: 0.6–0.8 g/kg/day to reduce uremic toxin load
In non-dialysis CKD stage 4, protein restriction to 0.6–0.8 g/kg/day helps slow progression and reduce uremic solute accumulation.
Question 2: When calculating energy needs using the Mifflin-St Jeor equation for a sedentary 45-year-old woman weighing 70 kg and 165 cm tall, which factor is multiplied by BMR?
- 1.200 (Correct answer)
- 1.375
- 1.550
- 1.725
Correct answer: 1.200
A sedentary activity factor of 1.200 (little or no exercise) is multiplied by BMR in the Mifflin-St Jeor equation.
Question 3: A hospitalized patient has a serum albumin of 2.8 g/dL and prealbumin of 10 mg/dL. These values primarily indicate:
- Adequate nutritional status
- Acute inflammatory response affecting protein synthesis (Correct answer)
- Overhydration diluting lab values
- Chronic liver disease only
Correct answer: Acute inflammatory response affecting protein synthesis
Low albumin and prealbumin in hospitalized patients often reflect acute-phase response rather than solely malnutrition, as inflammation suppresses hepatic synthesis.
Question 4: A dietitian is conducting a nutrition-focused physical exam (NFPE). Which finding would suggest zinc deficiency?
- Follicular hyperkeratosis
- Dermatitis around the mouth and acral areas (Correct answer)
- Bleeding gums
- Koilonychia
Correct answer: Dermatitis around the mouth and acral areas
Perioral and acral dermatitis (acrodermatitis enteropathica pattern) is a hallmark physical sign of zinc deficiency.
Question 5: Using the ASPEN definition, which combination meets criteria for malnutrition in a non-critically ill patient?
- BMI < 25 and mild appetite reduction for 1 week
- Inadequate energy intake and confirmed weight loss (Correct answer)
- Low albumin alone
- Subjective fatigue and reduced grip strength only
Correct answer: Inadequate energy intake and confirmed weight loss
ASPEN/AND malnutrition consensus requires at least 2 of 6 criteria, with inadequate energy intake plus weight loss being a common qualifying combination.
Question 6: A post-bariatric surgery patient 18 months post-Roux-en-Y gastric bypass presents with tingling in the feet and fatigue. Which deficiency should the RD suspect first?
- Vitamin D
- Iron
- Vitamin B12 (Correct answer)
- Calcium
Correct answer: Vitamin B12
Vitamin B12 deficiency is common after RYGB because intrinsic factor secretion and terminal ileum absorption are compromised, causing neurological symptoms.
Question 7: Which method is considered the gold standard for measuring resting metabolic rate (RMR) in clinical settings?
- Harris-Benedict equation
- Indirect calorimetry (Correct answer)
- Doubly labeled water
- Fick method
Correct answer: Indirect calorimetry
Indirect calorimetry measures RMR by analyzing oxygen consumption and carbon dioxide production and is the clinical gold standard.
Registered Dietitian Nutritionist Registered Dietitian Problem 2
A client with chronic kidney disease (CKD) stage 4 asks about protein intake.
Which recommendation is most appropriate?