Registered Dietitian Nutritionist Registered Dietitian Problem 3 — Questions and Answers
Question 1: A patient on total parenteral nutrition (TPN) develops hyperglycemia. The RD should recommend:
- Discontinuing TPN immediately
- Reducing dextrose concentration and adding insulin to the TPN bag if needed (Correct answer)
- Switching to lipid-only parenteral nutrition
- Increasing amino acid concentration to stabilize glucose
Correct answer: Reducing dextrose concentration and adding insulin to the TPN bag if needed
Managing TPN-related hyperglycemia involves reducing dextrose load and adding insulin to the formulation to maintain blood glucose between 140–180 mg/dL.
Question 2: A breastfeeding mother asks how to increase her milk supply. Which dietary recommendation has the strongest evidence?
- Consume fenugreek supplements daily
- Ensure adequate caloric intake and hydration (Correct answer)
- Avoid all dairy to reduce infant colic
- Take high-dose vitamin D3 supplements
Correct answer: Ensure adequate caloric intake and hydration
Adequate caloric intake (approximately 500 extra kcal/day) and hydration are the most evidence-based dietary strategies to support milk production.
Question 3: Which carbohydrate counting approach is recommended for a type 1 diabetic patient using an insulin-to-carb ratio?
- Count total calories only
- Count total carbohydrates including fiber in grams per meal (Correct answer)
- Avoid all carbohydrates at each meal
- Count only simple sugars and ignore complex carbohydrates
Correct answer: Count total carbohydrates including fiber in grams per meal
Total carbohydrate grams per meal are counted and matched to an individualized insulin-to-carb ratio to calculate mealtime insulin doses.
Question 4: A 78-year-old patient is at high fall risk with a BMI of 17.5. The RD's FIRST priority should be:
- Recommending a weight loss diet to improve mobility
- Conducting a comprehensive nutrition assessment to identify root causes of underweight (Correct answer)
- Prescribing a multivitamin only
- Referring solely to physical therapy
Correct answer: Conducting a comprehensive nutrition assessment to identify root causes of underweight
A comprehensive nutrition assessment must precede intervention to identify causes such as dysphagia, depression, or poverty-related food insecurity.
Question 5: The respiratory quotient (RQ) of a patient receiving a high-carbohydrate TPN formula is 1.2. This indicates:
- Adequate nutrition support
- Fat oxidation predominance
- Overfeeding with lipogenesis from excess carbohydrates (Correct answer)
- Protein catabolism
Correct answer: Overfeeding with lipogenesis from excess carbohydrates
An RQ above 1.0 indicates de novo lipogenesis due to carbohydrate overfeeding, increasing CO2 production and respiratory burden.
Question 6: Which mineral is most critical to monitor in a patient receiving long-term enteral nutrition with refeeding syndrome risk?
- Sodium
- Phosphorus (Correct answer)
- Magnesium
- Zinc
Correct answer: Phosphorus
Hypophosphatemia is the hallmark electrolyte abnormality of refeeding syndrome, caused by rapid cellular uptake of phosphate upon carbohydrate reintroduction.
Question 7: A client following a strict vegan diet reports fatigue and pallor. Which combination of nutrients is most likely deficient?
- Vitamin C and zinc
- Vitamin B12 and iron (Correct answer)
- Folate and calcium
- Omega-3 and vitamin K
Correct answer: Vitamin B12 and iron
Vegan diets lack heme iron and provide no vitamin B12 from food sources, making deficiencies in both nutrients common causes of fatigue and pallor.
Registered Dietitian Nutritionist Registered Dietitian Problem 3
A patient on total parenteral nutrition (TPN) develops hyperglycemia.
The RD should recommend: