Registered Dietitian Nutritionist Registered Dietitian Problem 5 — Questions and Answers
Question 1: A pregnant client in the second trimester asks about mercury exposure from fish. The RD should advise:
- Avoid all fish during pregnancy
- Consume up to 8–12 oz/week of low-mercury fish and limit high-mercury fish like swordfish (Correct answer)
- Limit fish to 4 oz/week regardless of species
- Only eat canned tuna daily for omega-3 benefits
Correct answer: Consume up to 8–12 oz/week of low-mercury fish and limit high-mercury fish like swordfish
FDA and EPA guidelines recommend 8–12 oz/week of low-mercury fish during pregnancy to provide DHA while limiting methylmercury exposure from high-mercury species.
Question 2: Which of the following is a modifiable risk factor for type 2 diabetes that an RD can directly address through MNT?
- Family history of diabetes
- Age over 45
- Excess body weight and physical inactivity (Correct answer)
- Ethnicity
Correct answer: Excess body weight and physical inactivity
Excess body weight and physical inactivity are the primary modifiable risk factors for type 2 diabetes addressable through medical nutrition therapy and lifestyle counseling.
Question 3: A patient with GERD asks about dietary strategies. Which recommendation is most evidence-based?
- Follow a strict low-acid diet eliminating all citrus and tomatoes
- Eat smaller, more frequent meals and avoid lying down within 2–3 hours of eating (Correct answer)
- Increase dietary fat to coat the esophagus
- Consume carbonated beverages to neutralize stomach acid
Correct answer: Eat smaller, more frequent meals and avoid lying down within 2–3 hours of eating
Smaller meals reduce gastric distension and acid production, while upright posture after eating prevents reflux of stomach contents into the esophagus.
Question 4: A client with celiac disease is confirmed adherent to a gluten-free diet but reports continued diarrhea and bloating. The RD should next assess for:
- Lactose intolerance as a co-existing condition (Correct answer)
- Vitamin C toxicity from supplement use
- Excessive dietary fiber from whole grains
- Caffeine sensitivity only
Correct answer: Lactose intolerance as a co-existing condition
Lactose intolerance frequently co-exists with celiac disease due to villous atrophy reducing lactase production, causing persistent GI symptoms even on a gluten-free diet.
Question 5: An RD is calculating nitrogen balance for an ICU patient receiving 100 g of protein per day. Urinary urea nitrogen (UUN) is 14 g/day. Assuming standard corrections, the nitrogen balance is approximately:
- -2 g/day
- +2 g/day (Correct answer)
- +6 g/day
- -6 g/day
Correct answer: +2 g/day
Nitrogen balance = (protein intake ÷ 6.25) − (UUN + 4); (100/6.25) − (14 + 4) = 16 − 18 = −2 g/day, indicating negative nitrogen balance and need for increased protein.
Question 6: When counseling an adolescent athlete on iron needs, the RD should note that iron requirements are increased by approximately how much compared to non-athletes?
- 10%
- 30–70% (Correct answer)
- 100–150%
- No difference from non-athletes
Correct answer: 30–70%
Endurance athletes may need 30–70% more dietary iron than non-athletes due to foot-strike hemolysis, GI losses, and increased red blood cell turnover.
Question 7: A community dietitian is designing a school nutrition program to reduce childhood obesity. Which intervention has the strongest evidence at the population level?
- Individual counseling sessions for overweight children
- Modifying the school food environment to increase availability of fruits and vegetables (Correct answer)
- Providing BMI report cards to parents
- Mandatory weight-loss goals for high-BMI students
Correct answer: Modifying the school food environment to increase availability of fruits and vegetables
Environmental interventions that increase access to healthier foods in schools have the strongest population-level evidence for improving dietary quality and reducing obesity rates.
Registered Dietitian Nutritionist Registered Dietitian Problem 5
A pregnant client in the second trimester asks about mercury exposure from fish.
The RD should advise: