Registered Dietitian Nutritionist Risk Assessment & Management 2 — Questions and Answers
Question 1: A 68-year-old patient with chronic kidney disease has a GFR of 28 mL/min. Which nutrient requires the most careful restriction to prevent hyperkalemia?
- Sodium
- Potassium (Correct answer)
- Phosphorus
- Magnesium
Correct answer: Potassium
With severely reduced GFR, the kidneys cannot adequately excrete potassium, making dietary potassium restriction critical to prevent life-threatening hyperkalemia.
Question 2: When using the Malnutrition Screening Tool (MST), which two factors are assessed?
- Weight loss and appetite (Correct answer)
- BMI and albumin
- Muscle mass and edema
- Food intake and inflammation
Correct answer: Weight loss and appetite
The MST screens for malnutrition risk using recent unintentional weight loss and poor appetite as its two key parameters.
Question 3: A patient on warfarin asks about increasing vitamin K intake. What is the safest evidence-based recommendation?
- Eliminate all green vegetables
- Maintain consistent daily vitamin K intake (Correct answer)
- Supplement with vitamin K to normalize INR
- Avoid all vitamin K-containing foods
Correct answer: Maintain consistent daily vitamin K intake
Consistent, moderate vitamin K intake allows anticoagulation therapy to be titrated appropriately rather than causing erratic INR fluctuations from variable intake.
Question 4: Which condition is most associated with refeeding syndrome risk when initiating nutrition support?
- Mild obesity with recent 5% weight loss
- Prolonged starvation or severe malnutrition (Correct answer)
- Type 2 diabetes with HbA1c of 8%
- Inflammatory bowel disease in remission
Correct answer: Prolonged starvation or severe malnutrition
Refeeding syndrome occurs when carbohydrates are reintroduced after prolonged starvation, triggering a rapid intracellular shift of phosphate, potassium, and magnesium.
Question 5: A critically ill patient develops hyperglycemia during enteral nutrition. What is the primary clinical risk associated with persistent hyperglycemia in this population?
- Increased risk of hyperlipidemia
- Impaired immune function and increased infection risk (Correct answer)
- Accelerated muscle protein synthesis
- Reduced gastrointestinal motility only
Correct answer: Impaired immune function and increased infection risk
Hyperglycemia in critically ill patients significantly impairs neutrophil function and promotes bacterial growth, substantially increasing infection-related morbidity and mortality.
Question 6: Which anthropometric measurement is most useful for assessing visceral adiposity and cardiometabolic risk?
- Body mass index
- Waist circumference (Correct answer)
- Triceps skinfold thickness
- Mid-upper arm circumference
Correct answer: Waist circumference
Waist circumference directly reflects intra-abdominal fat accumulation, which is the primary driver of insulin resistance and cardiovascular risk independent of total body weight.
Question 7: A client with celiac disease continues to have elevated tissue transglutaminase (tTG) antibodies after one year on a gluten-free diet. What is the most likely explanation?
- Celiac disease has resolved and antibodies are lagging
- Hidden gluten exposure through cross-contamination or mislabeled foods (Correct answer)
- The gluten-free diet is causing nutritional deficiency
- tTG antibodies are not diagnostic for celiac disease
Correct answer: Hidden gluten exposure through cross-contamination or mislabeled foods
Persistent elevated tTG-IgA antibodies after adopting a gluten-free diet strongly suggest ongoing gluten exposure, most commonly from cross-contamination, shared utensils, or inadequate food label reading.
Registered Dietitian Nutritionist Risk Assessment & Management 2
A 68-year-old patient with chronic kidney disease has a GFR of 28 mL/min.
Which nutrient requires the most careful restriction to prevent hyperkalemia?