Registered Dietitian Nutritionist Registered Dietitian Problem 4 — Questions and Answers
Question 1: A patient with Crohn's disease involving the terminal ileum is most at risk for deficiency of which nutrient?
- Thiamine
- Vitamin B12 (Correct answer)
- Niacin
- Vitamin C
Correct answer: Vitamin B12
The terminal ileum is the sole site of vitamin B12 absorption via intrinsic factor receptors, so Crohn's disease affecting this region causes B12 malabsorption.
Question 2: A dietitian is developing a SMART goal for a patient with hypertension. Which goal best meets all SMART criteria?
- Eat healthier foods starting next month
- Reduce sodium intake to under 2,300 mg/day by tracking intake with a food diary for 4 weeks (Correct answer)
- Try to eat less salt when possible
- Avoid processed food forever
Correct answer: Reduce sodium intake to under 2,300 mg/day by tracking intake with a food diary for 4 weeks
The goal is Specific (sodium <2,300 mg/day), Measurable (food diary tracking), Achievable, Relevant (hypertension management), and Time-bound (4 weeks).
Question 3: Which dietary pattern has the strongest evidence for reducing LDL cholesterol without medication?
- Ketogenic diet
- Portfolio diet (Correct answer)
- Intermittent fasting
- Carnivore diet
Correct answer: Portfolio diet
The Portfolio diet, which combines plant sterols, viscous fiber, soy protein, and nuts, has demonstrated LDL reductions comparable to first-generation statins.
Question 4: A 6-month-old infant's parent asks when to introduce complementary foods. The RD should advise:
- At 3 months to improve sleep
- Around 6 months when the infant shows developmental readiness signs (Correct answer)
- At 8 months minimum to protect gut health
- After the first birthday to reduce allergy risk
Correct answer: Around 6 months when the infant shows developmental readiness signs
AAP and WHO recommend introducing complementary foods around 6 months when infants show readiness such as head control and interest in food, while continuing breastfeeding.
Question 5: During a food security screening, a patient endorses the USDA Household Food Insecurity Access Scale question: 'We worried our food would run out before we got money to buy more.' This reflects which category?
- Food secure
- Marginal food insecurity (Correct answer)
- Low food security
- Very low food security
Correct answer: Marginal food insecurity
Endorsing the 'worried food would run out' item alone without reporting reduced intake places the household in the marginal food insecurity category.
Question 6: A patient with phenylketonuria (PKU) requires strict dietary management. Which amino acid must be restricted?
- Tyrosine
- Phenylalanine (Correct answer)
- Leucine
- Methionine
Correct answer: Phenylalanine
PKU is caused by deficient phenylalanine hydroxylase, so phenylalanine from dietary protein must be restricted to prevent neurotoxic accumulation.
Question 7: A dialysis patient consuming 2,000 kcal/day has a serum potassium of 6.2 mEq/L. Which dietary modification is most appropriate?
- Increase fluid intake to dilute serum potassium
- Restrict dietary potassium to 2,000–3,000 mg/day and leach high-potassium vegetables (Correct answer)
- Switch to a high-fruit diet for antioxidants
- Increase protein intake to bind potassium
Correct answer: Restrict dietary potassium to 2,000–3,000 mg/day and leach high-potassium vegetables
Hyperkalemia in dialysis requires potassium restriction typically to 2,000–3,000 mg/day, with leaching techniques applied to high-potassium vegetables to reduce content.
Registered Dietitian Nutritionist Registered Dietitian Problem 4
A patient with Crohn's disease involving the terminal ileum is most at risk for deficiency of which nutrient?