Registered Dietitian Nutritionist Risk Assessment & Management 4 — Questions and Answers
Question 1: A patient with type 1 diabetes is starting an intensive exercise program. What is the primary nutritional risk that must be managed?
- Hyperkalemia from muscle breakdown
- Exercise-induced hypoglycemia (Correct answer)
- Protein deficiency from increased catabolism
- Vitamin D deficiency from increased sweating
Correct answer: Exercise-induced hypoglycemia
Exercise increases glucose uptake by muscles independent of insulin, and combined with insulin therapy in type 1 diabetes, this substantially raises the risk of hypoglycemia during and after exercise.
Question 2: When counseling a pregnant patient about listeriosis risk, which food should be specifically avoided?
- Well-done hamburgers
- Soft cheeses like brie and camembert (Correct answer)
- Pasteurized milk
- Thoroughly cooked chicken
Correct answer: Soft cheeses like brie and camembert
Soft cheeses made from unpasteurized milk harbor Listeria monocytogenes, which poses catastrophic risk in pregnancy including miscarriage, stillbirth, and neonatal meningitis.
Question 3: A patient presents with pellagra. Which nutrient deficiency is responsible for this condition?
- Thiamine (B1)
- Riboflavin (B2)
- Niacin (B3) (Correct answer)
- Pyridoxine (B6)
Correct answer: Niacin (B3)
Pellagra is caused by severe niacin (vitamin B3) deficiency and is characterized by the 4 D's: dermatitis, diarrhea, dementia, and death if untreated.
Question 4: Which patient scenario represents the highest risk for iron-deficiency anemia requiring nutritional intervention?
- A 35-year-old male eating a balanced omnivore diet
- A 22-year-old vegan female with heavy menstrual periods (Correct answer)
- A 60-year-old male consuming red meat three times weekly
- A 45-year-old female post-menopause on an omnivore diet
Correct answer: A 22-year-old vegan female with heavy menstrual periods
Young vegan women with heavy menstrual blood loss face compounded iron-deficiency risk: high physiological losses, lower dietary iron intake, and reduced bioavailability of non-heme iron.
Question 5: A patient with short bowel syndrome (SBS) following massive intestinal resection is at highest risk for deficiency of which vitamin due to loss of the ileum?
- Vitamin C
- Vitamin B12 (Correct answer)
- Vitamin A
- Vitamin E
Correct answer: Vitamin B12
Vitamin B12 absorption requires intrinsic factor binding and active transport in the terminal ileum; resection of this segment causes permanent B12 malabsorption requiring parenteral supplementation.
Question 6: In the context of HACCP (Hazard Analysis and Critical Control Points), which temperature range is defined as the 'danger zone' for bacterial growth?
- 20°F to 80°F (-6.7°C to 26.7°C)
- 40°F to 140°F (4.4°C to 60°C) (Correct answer)
- 32°F to 100°F (0°C to 37.8°C)
- 50°F to 165°F (10°C to 73.9°C)
Correct answer: 40°F to 140°F (4.4°C to 60°C)
The USDA defines the temperature danger zone as 40°F–140°F, the range where most foodborne pathogens multiply rapidly and can reach unsafe levels within 2 hours.
Question 7: A dietitian is reviewing a patient's labs and notes serum phosphorus of 6.8 mg/dL in a dialysis patient. What is the primary dietary intervention?
- Increase calcium-rich foods to bind phosphorus
- Restrict dietary phosphorus and review phosphate binder adherence (Correct answer)
- Increase fluid intake to flush excess phosphorus
- Recommend a high-protein diet to correct the imbalance
Correct answer: Restrict dietary phosphorus and review phosphate binder adherence
Hyperphosphatemia in dialysis patients requires dietary phosphorus restriction combined with phosphate binders taken with meals to prevent renal osteodystrophy and cardiovascular calcification.
Registered Dietitian Nutritionist Risk Assessment & Management 4
A patient with type 1 diabetes is starting an intensive exercise program.
What is the primary nutritional risk that must be managed?