Registered Dietitian Nutritionist Risk Assessment & Management 5 — Questions and Answers
Question 1: A registered dietitian is screening a patient using the NRS-2002 tool. A score of 3 or more indicates what?
- The patient is well-nourished and requires routine follow-up
- The patient is at nutritional risk and requires a full nutrition care plan (Correct answer)
- The patient requires immediate parenteral nutrition
- The score is insufficient to make any clinical decision
Correct answer: The patient is at nutritional risk and requires a full nutrition care plan
An NRS-2002 score ≥3 identifies patients at nutritional risk in hospital settings, triggering initiation of a comprehensive nutrition care plan per evidence-based guidelines.
Question 2: Which drug-nutrient interaction poses a life-threatening risk when tyramine-rich foods are consumed?
- Metformin and vitamin B12
- MAO inhibitors and aged cheese (Correct answer)
- Statins and grapefruit juice
- Tetracycline and dairy products
Correct answer: MAO inhibitors and aged cheese
MAO inhibitors block tyramine metabolism, causing dangerous accumulation when tyramine-rich foods like aged cheese are eaten, leading to hypertensive crisis.
Question 3: A patient with obesity and metabolic syndrome has a fasting triglyceride level of 580 mg/dL. Which dietary modification is most urgently needed to reduce pancreatitis risk?
- Eliminate all dietary cholesterol
- Severely restrict dietary fat to less than 15% of calories
- Increase omega-3 fatty acid supplementation only
- Restrict carbohydrate and alcohol intake (Correct answer)
Correct answer: Restrict carbohydrate and alcohol intake
Severely elevated triglycerides in metabolic syndrome are primarily driven by refined carbohydrate and alcohol intake, which stimulate hepatic VLDL production; restricting these substrates rapidly reduces triglyceride levels.
Question 4: A nursing home resident is assessed using the Braden Scale and scores a 14. What is the primary nutritional priority for pressure injury prevention?
- Restrict fluid intake to prevent edema
- Ensure adequate protein (1.2–1.5 g/kg/day) and hydration (Correct answer)
- Increase carbohydrate intake for wound energy
- Supplement with high-dose zinc only
Correct answer: Ensure adequate protein (1.2–1.5 g/kg/day) and hydration
Adequate protein (1.2–1.5 g/kg/day) is essential for tissue repair and maintenance, while hydration preserves skin turgor; both are critical for pressure injury prevention and healing.
Question 5: Which assessment finding most strongly indicates the need for a nutrition-focused physical exam (NFPE) to confirm sarcopenia?
- BMI of 32 with stable weight
- Normal serum albumin with unintentional 10% weight loss over 6 months (Correct answer)
- Elevated CRP with mild overweight
- Normal hand grip strength with BMI of 19
Correct answer: Normal serum albumin with unintentional 10% weight loss over 6 months
Significant unintentional weight loss (≥5% in 6 months) with preserved or low albumin warrants NFPE to assess muscle wasting, which may be masked by normal or high BMI.
Question 6: A patient with cirrhosis and hepatic encephalopathy is admitted. What is the current evidence-based approach to protein management?
- Severely restrict protein to 0.5 g/kg/day to reduce ammonia
- Provide adequate protein (1.2–1.5 g/kg/day) with preference for branched-chain amino acids (Correct answer)
- Eliminate all protein until encephalopathy resolves
- Use standard protein restriction of 0.8 g/kg/day only
Correct answer: Provide adequate protein (1.2–1.5 g/kg/day) with preference for branched-chain amino acids
Current evidence rejects protein restriction in hepatic encephalopathy; adequate protein (1.2–1.5 g/kg/day) is needed to prevent sarcopenia, with branched-chain amino acids preferred to reduce ammonia load.
Question 7: When calculating a patient's estimated energy needs using the Mifflin-St Jeor equation, which variable is NOT included in the formula?
- Age
- Height
- Serum albumin (Correct answer)
- Weight
Correct answer: Serum albumin
The Mifflin-St Jeor equation uses age, height, weight, and sex to calculate resting metabolic rate; serum albumin is a biochemical marker unrelated to this predictive equation.
Registered Dietitian Nutritionist Risk Assessment & Management 5
A registered dietitian is screening a patient using the NRS-2002 tool.
A score of 3 or more indicates what?