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Question 1Clinical Nutrition

A patient with chronic kidney disease not on dialysis has a serum potassium of 5.8 mEq/L. Which dietary instruction is most appropriate?

  1. Limit high-potassium foods such as potatoes, bananas, and tomatoes Correct answer.
  2. Increase dairy intake to three or more servings daily
  3. Increase intake of oranges and bananas to support potassium balance
  4. Add salt substitutes freely to improve flavor without restriction

Explanation

Hyperkalemia in CKD requires restricting foods concentrated in potassium, including potatoes, bananas, tomatoes, and oranges. Salt substitutes are typically potassium chloride and would worsen hyperkalemia. Dairy is also high in potassium and phosphorus, so increasing it is inappropriate.

Question 2Clinical Nutrition

Which anthropometric measurement is most useful for estimating visceral fat and metabolic risk in a nutrition assessment?

  1. Waist circumference Correct answer.
  2. Wrist circumference
  3. Calf circumference
  4. Mid-upper arm circumference

Explanation

Waist circumference reflects abdominal (visceral) adiposity and correlates with cardiometabolic risk. Mid-upper arm and calf circumference estimate muscle mass or nutritional status rather than central adiposity. Wrist circumference is used for frame size, not metabolic risk.

Question 3Clinical Nutrition

A patient with type 1 diabetes reports frequent hypoglycemia after morning insulin. Which nutrition intervention is most appropriate?

  1. Eliminate all carbohydrates from the diet
  2. Add a consistent carbohydrate snack between meals Correct answer.
  3. Increase simple sugars at breakfast
  4. Skip breakfast to reduce insulin requirements

Explanation

Consistent carbohydrate intake with planned snacks helps match insulin action and prevent hypoglycemia in type 1 diabetes. Skipping meals or eliminating carbohydrates increases hypoglycemia risk and is not recommended. Increasing simple sugars at breakfast would cause glycemic excursions.

Question 4Clinical Nutrition

Which laboratory value is the most specific indicator of iron deficiency anemia?

  1. Hemoglobin
  2. Mean corpuscular volume
  3. Total iron-binding capacity
  4. Serum ferritin Correct answer.

Explanation

Serum ferritin reflects body iron stores and is the most specific single indicator of iron deficiency, though it rises with inflammation. Hemoglobin and MCV fall only after stores are depleted and are less specific. TIBC rises in deficiency but is influenced by other conditions.

Question 5Clinical Nutrition

A postoperative patient is starting enteral nutrition. Which position minimizes aspiration risk during tube feeding?

  1. Prone position
  2. Left lateral decubitus position
  3. Supine with the head flat
  4. Head of bed elevated 30 to 45 degrees Correct answer.

Explanation

Elevating the head of the bed 30 to 45 degrees during and after tube feeding reduces gastroesophageal reflux and aspiration risk. Supine and prone positions promote regurgitation. Lateral positioning does not provide the same protective effect.

Question 6Clinical Nutrition

Which food is the most appropriate source of complete protein for a vegan patient?

  1. Almonds
  2. Brown rice
  3. Soybeans Correct answer.
  4. Spinach

Explanation

Soybeans provide all essential amino acids in adequate amounts and are a complete plant protein. Brown rice and almonds are limiting in lysine and are incomplete alone. Spinach is low in protein and not a practical protein source.

Question 7Clinical Nutrition

A patient with cirrhosis and ascites should follow which sodium restriction?

  1. No sodium restriction is needed
  2. Restrict sodium to less than 500 mg per day
  3. Restrict sodium to about 2 grams per day Correct answer.
  4. Restrict fluid to 500 mL per day instead

Explanation

Sodium restriction of approximately 2 g per day (about 88 mEq) is standard for ascites management in cirrhosis. Severe restriction below 500 mg is unnecessary and impairs palatability. Fluid restriction is reserved for hyponatremia and does not replace sodium restriction.

Question 8Clinical Nutrition

A breastfeeding mother asks how to increase her milk supply. Which recommendation is best supported?

  1. Supplement with formula to allow breast rest
  2. Feed or pump frequently to stimulate prolactin release Correct answer.
  3. Restrict fluids to reduce engorgement
  4. Delay feeding until the breasts feel full

Explanation

Frequent milk removal stimulates prolactin and maintains supply through supply-and-demand feedback. Fluid restriction does not reduce engorgement and may impair milk production. Formula supplementation and delayed feeding reduce stimulation and lower supply.

Question 9Clinical Nutrition

A patient with a body mass index of 32 kg/m2 and type 2 diabetes is starting medical nutrition therapy. Which approach is recommended first?

  1. Elimination of all dietary fat
  2. A very-low-calorie diet below 800 kcal daily for all patients
  3. Modest energy deficit with 5 to 10 percent weight loss goal Correct answer.
  4. High-protein diet above 2 g/kg daily

Explanation

A modest energy deficit targeting 5 to 10 percent weight loss improves glycemia and is sustainable in type 2 diabetes. Very-low-calorie diets require supervision and are not universal. Fat elimination and very high protein intakes are not standard first-line recommendations.

Question 10Clinical Nutrition

Which parameter best assesses adequacy of dialysis in a hemodialysis patient?

  1. Dietary protein intake reported by the patient
  2. Body mass index
  3. Serum albumin alone
  4. Kt/V urea Correct answer.

Explanation

Kt/V urea quantifies urea clearance during dialysis and is the standard measure of dialysis adequacy. Albumin reflects nutritional and inflammatory status but not clearance. BMI and reported protein intake do not measure dialysis dose.

Question 11Clinical Nutrition

A patient with short bowel syndrome has high ostomy output. Which strategy best supports fluid and electrolyte balance?

  1. Use an oral rehydration solution with sodium and glucose Correct answer.
  2. Increase intake of sugar-sweetened beverages
  3. Restrict all oral fluids
  4. Drink large volumes of plain water with meals

Explanation

Oral rehydration solutions with balanced sodium and glucose use sodium-glucose cotransport to enhance absorption and reduce ostomy losses. Plain water and sugary drinks worsen osmotic losses. Complete fluid restriction is not appropriate.

Question 12Clinical Nutrition

A patient with pancreatitis is advancing from a clear liquid diet. Which feeding approach is preferred when tolerated?

  1. Parenteral nutrition immediately
  2. Low-fat oral diet advanced as tolerated Correct answer.
  3. High-fat diet to provide energy
  4. Complete bowel rest for two weeks

Explanation

Early oral feeding with a low-fat diet advanced as tolerated is preferred in acute pancreatitis once the patient is stable. Parenteral nutrition is reserved for intolerance or complications. High-fat diets may aggravate symptoms, and prolonged bowel rest is avoided when possible.

Question 13Clinical Nutrition

Which nutrition intervention is recommended for a patient with pressure injuries and inadequate oral intake?

  1. Withhold zinc and vitamin C
  2. Restrict protein to 0.8 g/kg daily
  3. Provide high-calorie, high-protein oral supplements Correct answer.
  4. Limit fluids to 1 liter daily

Explanation

Pressure injury healing increases energy and protein needs, and high-calorie, high-protein oral nutrition supplements help meet them when intake is inadequate. Protein restriction impairs wound healing. Fluid restriction and withholding micronutrients such as vitamin C and zinc are not appropriate.

Question 14Clinical Nutrition

A patient is receiving warfarin and asks about diet. Which instruction is correct?

  1. Increase vitamin K to 500 percent of needs
  2. Take vitamin K supplements daily
  3. Avoid all green vegetables permanently
  4. Keep vitamin K intake consistent from day to day Correct answer.

Explanation

Warfarin antagonizes vitamin K, so maintaining a consistent daily vitamin K intake stabilizes the INR. Eliminating green vegetables is unnecessary and may reduce diet quality. Large increases or supplements can reduce warfarin effect.

Question 15Clinical Nutrition

A patient with celiac disease must avoid which grain protein?

  1. Casein in milk
  2. Gluten in wheat, barley, and rye Correct answer.
  3. Lectin in legumes
  4. Albumin in egg white

Explanation

Celiac disease requires lifelong avoidance of gluten from wheat, barley, and rye. Egg albumin and milk casein are unrelated proteins and are not restricted unless separate allergy exists. Legume lectins are not the trigger for celiac disease.

Question 16Clinical Nutrition

Which dietary pattern is most consistent with the DASH eating plan?

  1. Rich in fruits, vegetables, and low-fat dairy Correct answer.
  2. High in saturated fat and refined grains
  3. High in sodium and low in potassium
  4. High in processed meats and sodium

Explanation

DASH emphasizes fruits, vegetables, low-fat dairy, whole grains, and lean proteins while limiting sodium and saturated fat. It is rich in potassium, calcium, and magnesium. High-sodium, high-saturated-fat, and processed-meat patterns are opposite to DASH.

Question 17Clinical Nutrition

A patient with chronic obstructive pulmonary disease is losing weight. Which nutrition strategy is most appropriate?

  1. A clear liquid diet for two weeks
  2. Restricting protein to reduce breathing effort
  3. A very-low-calorie diet to reduce oxygen demand
  4. Small, frequent, nutrient-dense meals with adequate protein Correct answer.

Explanation

Small, frequent, nutrient-dense meals reduce the work of eating while meeting elevated energy and protein needs in COPD. Weight loss worsens respiratory muscle function. Very-low-calorie diets, protein restriction, and prolonged clear liquids worsen malnutrition.

Question 18Clinical Nutrition

Which marker reflects short-term changes in nutritional status and is often used to monitor acute response?

  1. Serum albumin
  2. Hemoglobin
  3. Prealbumin Correct answer.
  4. Serum ferritin

Explanation

Prealbumin has a shorter half-life than albumin and responds more quickly to changes in protein-energy status, though it is affected by inflammation. Albumin has a long half-life and is a poor short-term marker. Hemoglobin and ferritin reflect anemia and iron status, not short-term nutrition.

Question 19Clinical Nutrition

A patient with gout is advised on diet. Which recommendation is most appropriate?

  1. Limit purine-rich foods and alcohol Correct answer.
  2. Increase fructose-sweetened beverages
  3. Restrict all protein to zero
  4. Increase intake of organ meats and shellfish

Explanation

Limiting purine-rich foods such as organ meats and shellfish, along with alcohol, reduces uric acid production in gout. Fructose-sweetened beverages raise uric acid. Complete protein elimination is unnecessary and harmful.

Question 20Clinical Nutrition

Which vitamin deficiency is most associated with prolonged exclusive breastfeeding without supplementation?

  1. Thiamine
  2. Vitamin K
  3. Vitamin D Correct answer.
  4. Vitamin C

Explanation

Breast milk contains limited vitamin D, so exclusively breastfed infants require vitamin D supplementation to prevent rickets. Vitamin K deficiency is prevented with the birth dose of vitamin K. Vitamin C and thiamine deficiencies are not typical of exclusive breastfeeding in adequately nourished mothers.

Question 21Clinical Nutrition

A patient with severe acute kidney injury and hypercatabolism is started on renal replacement therapy. Which protein intake is most appropriate?

  1. 0.4 g/kg daily
  2. 3.5 g/kg daily
  3. 0.8 g/kg daily
  4. 1.2 to 1.5 g/kg daily or higher Correct answer.

Explanation

Patients with severe acute kidney injury on renal replacement therapy have increased protein losses and catabolism, so 1.2 to 1.5 g/kg daily or higher is often needed. Lower intakes risk negative nitrogen balance. Extremely high intake above 3 g/kg is not standard.

Question 22Clinical Nutrition

A patient with advanced cirrhosis has refractory ascites and hyponatremia. Which combination is most appropriate?

  1. Liberal sodium and unrestricted fluids
  2. High-protein restriction below 0.5 g/kg daily
  3. Sodium restriction alone without addressing fluids
  4. Moderate sodium restriction plus fluid restriction to about 1 to 1.5 L daily Correct answer.

Explanation

Refractory ascites with hyponatremia typically requires moderate sodium restriction plus fluid restriction around 1 to 1.5 L daily. Liberal sodium worsens ascites. Severe protein restriction is not indicated and worsens malnutrition. Sodium restriction alone may not correct hyponatremia.

Question 23Clinical Nutrition

A patient with a jejunostomy tolerates only small volumes of formula. Which formula characteristic is most appropriate?

  1. Hypertonic formula delivered in large boluses
  2. High-fiber formula given as rapid boluses
  3. Isotonic formula delivered by continuous infusion Correct answer.
  4. Concentrated formula with high osmolality

Explanation

Isotonic formula delivered by continuous infusion is best tolerated in jejunal feeding because it reduces osmotic load and dumping. Hypertonic or concentrated formulas in large boluses increase diarrhea and dumping risk. Rapid boluses of high-fiber formula are poorly tolerated.

Question 24Clinical Nutrition

A patient with chronic kidney disease and diabetes has a serum phosphorus of 6.2 mg/dL. Which dietary change is most appropriate?

  1. Limit phosphate additives and high-phosphorus foods Correct answer.
  2. Increase intake of processed foods and colas
  3. Add more dairy to increase calcium intake
  4. Increase whole grains to boost fiber

Explanation

Phosphate additives in processed foods and colas are highly bioavailable and raise serum phosphorus, so limiting them along with high-phosphorus foods is appropriate. Dairy and whole grains are also high in phosphorus and may need portion control rather than increase.

Question 25Clinical Nutrition

A patient with severe malnutrition is at risk for refeeding syndrome. Which electrolyte should be monitored most closely during initial refeeding?

  1. Serum phosphate Correct answer.
  2. Serum calcium
  3. Serum sodium
  4. Serum chloride

Explanation

Refeeding syndrome is characterized by a rapid intracellular shift of phosphate, causing hypophosphatemia that can lead to cardiac and respiratory failure. Sodium, calcium, and chloride are less central to the syndrome, though magnesium and potassium also require monitoring.

Question 26Clinical Nutrition

A patient with type 1 diabetes is taught carbohydrate counting to match insulin doses. Which meal-planning principle best supports this approach?

  1. Choosing foods by glycemic index alone without regard to portion size
  2. Counting total grams of carbohydrate per meal and adjusting rapid-acting insulin accordingly Correct answer.
  3. Eating the same fixed menu at identical times every day regardless of insulin timing
  4. Restricting all carbohydrate-containing foods to eliminate postprandial glucose excursions

Explanation

Carbohydrate counting pairs the total grams of carbohydrate eaten with a matching dose of rapid-acting insulin, allowing flexibility in timing and food choice. Portion accuracy and consistency of counting technique are what make the method reliable.

Question 27Clinical Nutrition

A hospitalized patient with an eating disorder and severe weight loss is being refed. Which laboratory value should be checked before feeding is advanced and then rechecked frequently?

  1. Serum calcium
  2. Serum bilirubin
  3. Serum albumin
  4. Serum phosphate Correct answer.

Explanation

Hypophosphatemia is the hallmark biochemical feature of refeeding syndrome, arising when insulin surges drive phosphate intracellularly during reintroduction of carbohydrate. Phosphate is therefore checked before feeding and monitored closely as intake advances.

Question 28Clinical Nutrition

A patient with chronic kidney disease not on dialysis asks which protein intake is generally recommended when the goal is to slow progression while maintaining nutritional status.

  1. No protein restriction is needed at any stage of CKD
  2. 1.5 to 2.0 g/kg/day to prevent muscle wasting
  3. 2.5 g/kg/day to replace urinary losses
  4. 0.6 to 0.8 g/kg/day of primarily high-biologic-value protein Correct answer.

Explanation

Guidelines support a moderate protein restriction of roughly 0.6 to 0.8 g/kg/day for non-dialyzed CKD to reduce hyperfiltration and progression, emphasizing adequate energy and high-biologic-value sources. Very high intakes increase nitrogenous waste and may accelerate decline.

Question 29Clinical Nutrition

A patient reports bloating, cramping, and diarrhea after drinking milk but tolerates yogurt and hard cheese. Which explanation best fits this pattern?

  1. Lactose malabsorption, because fermented and aged dairy contain less lactose Correct answer.
  2. Cow milk protein allergy, because yogurt contains the same protein as milk
  3. Small intestinal bacterial overgrowth, because yogurt is sterile
  4. Celiac disease, because dairy products frequently contain gluten

Explanation

Symptoms limited to high-lactose dairy with tolerance of yogurt and aged cheese point to lactase deficiency, since fermentation and aging reduce lactose content. Protein allergy would typically also react to yogurt and cheese.

Question 30Clinical Nutrition

Which anthropometric measure is most appropriate for tracking nutritional status in a patient with severe ascites?

  1. Serial body weight
  2. Body mass index from current weight
  3. Bioelectrical impedance analysis
  4. Mid-upper arm circumference Correct answer.

Explanation

Ascites and edema inflate body weight and derived indices such as BMI, so a compartment measure like mid-upper arm circumference better reflects lean mass. Bioelectrical impedance is also distorted by fluid overload.

Question 31Clinical Nutrition

A patient with hypertension is counseled on the DASH pattern. Which change is central to that eating plan?

  1. Increasing red meat and refined grains while limiting dairy
  2. Restricting fluid intake to less than one liter per day
  3. Increasing fruits, vegetables, and low-fat dairy while limiting sodium Correct answer.
  4. Replacing meals with liquid protein supplements

Explanation

DASH emphasizes potassium-rich fruits and vegetables, low-fat dairy, whole grains, and limited sodium, saturated fat, and sweets. This pattern lowers blood pressure in trials.

Question 32Clinical Nutrition

A patient with a new ileostomy is discharged. Which dietary guidance is most appropriate in the early postoperative period?

  1. Avoid all fluids between meals to thicken output
  2. Drink large volumes of fluid with each meal to flush the stoma
  3. Eat small frequent meals and chew thoroughly while reintroducing foods one at a time Correct answer.
  4. Increase intake of raw vegetables and whole nuts to promote bulk

Explanation

Early after ileostomy formation, small frequent meals, thorough chewing, and stepwise reintroduction help identify tolerated foods and reduce obstruction risk. High-fiber foods and large fluid volumes with meals may worsen output or cause blockage.

Question 33Clinical Nutrition

Which food is the richest dietary source of iodine among the options below?

  1. Fresh apples
  2. White rice
  3. Olive oil
  4. Iodized table salt Correct answer.

Explanation

Iodized salt is a major dietary iodine source in many countries and is a key public health vehicle for preventing deficiency. Plant and fat sources listed contain negligible iodine.

Question 34Clinical Nutrition

A patient with heart failure and recurrent fluid retention is being counseled on sodium. Which statement best reflects appropriate advice?

  1. Add salt at the table but avoid salt in cooking
  2. Use potassium-based salt substitutes without checking renal function
  3. Rely on how salty a food tastes to judge its sodium content
  4. Read Nutrition Facts labels and choose foods with lower sodium per serving Correct answer.

Explanation

Label reading is the practical tool for identifying hidden sodium in processed foods, which is the dominant contributor to intake. Taste is an unreliable guide, and salt substitutes carry potassium risk.

Question 35Clinical Nutrition

A patient with type 2 diabetes wants to reduce postprandial glucose spikes. Which strategy is best supported?

  1. Choosing only foods labeled sugar-free
  2. Skipping breakfast and lunch to lower total carbohydrate exposure
  3. Drinking fruit juice instead of eating whole fruit
  4. Pairing carbohydrate foods with protein or fat and choosing higher-fiber carbohydrates Correct answer.

Explanation

Combining carbohydrate with protein or fat and selecting fiber-rich carbohydrates slows gastric emptying and blunts postprandial glucose rise. Whole fruit provides fiber that juice lacks, and sugar-free labels do not guarantee low glycemic impact.

Question 36Clinical Nutrition

A patient with cirrhosis is found to have a low serum albumin and muscle wasting. Which nutrition plan is most appropriate?

  1. Provide 1.2 to 1.5 g/kg/day of protein with a late-evening snack Correct answer.
  2. Restrict protein to 0.6 g/kg/day to prevent encephalopathy
  3. Provide a clear liquid diet until albumin normalizes
  4. Restrict protein only during acute encephalopathy and otherwise provide 0.8 g/kg/day

Explanation

Cirrhosis is a catabolic state with increased protein needs, and guidelines recommend roughly 1.2 to 1.5 g/kg/day along with a late-evening carbohydrate snack to reduce catabolism. Protein restriction is not indicated for chronic hepatic encephalopathy and worsens malnutrition.

Question 37Clinical Nutrition

A patient with acute pancreatitis is admitted with severe pain and vomiting. Which nutrition approach is preferred once resuscitation is underway and the patient is hemodynamically stable?

  1. Begin oral or enteral feeding as soon as tolerated rather than keeping the patient NPO for prolonged periods Correct answer.
  2. Provide only clear liquids for the first five days
  3. Keep the patient NPO for at least seven days to rest the pancreas
  4. Start total parenteral nutrition immediately on admission

Explanation

Early enteral or oral feeding as tolerated shortens hospital stay and reduces complications compared with prolonged fasting. Parenteral nutrition is reserved for patients who cannot be fed enterally.

Question 38Clinical Nutrition

A patient with chronic obstructive pulmonary disease is cachectic and reports early satiety. Which strategy is most appropriate?

  1. Offer small frequent energy-dense meals and oral nutrition supplements between meals Correct answer.
  2. Recommend large volume meals three times daily
  3. Advise a very-low-calorie diet to reduce the work of breathing
  4. Prescribe a high-carbohydrate, low-fat diet to improve respiratory quotient

Explanation

Small, frequent, energy-dense meals with between-meal supplements improve intake when early satiety limits meal size. Excessive carbohydrate increases carbon dioxide production, and calorie restriction worsens cachexia.

Question 39Clinical Nutrition

A patient with short bowel syndrome has a jejunostomy and high output. Which strategy best supports absorption?

  1. Provide free water only between feeds and avoid oral rehydration solutions
  2. Provide continuous enteral feeding with an isotonic formula and restrict hypertonic fluids Correct answer.
  3. Encourage a high-simple-sugar diet to increase energy density
  4. Give bolus feeds of concentrated formula to stimulate adaptation

Explanation

Continuous, isotonic enteral feeding improves tolerance and absorption in short bowel syndrome, while hypertonic boluses and simple sugars worsen osmotic output. Oral rehydration solutions with appropriate sodium and glucose enhance sodium-coupled water absorption.

Question 40Clinical Nutrition

A patient with a stage 3 pressure injury has inadequate oral intake despite encouragement. Which intervention is most appropriate?

  1. Restrict protein to 0.8 g/kg/day to reduce wound exudate
  2. Provide 30 to 35 kcal/kg/day and 1.25 to 1.5 g/kg/day of protein with high-calorie, high-protein supplements Correct answer.
  3. Provide a standard diet with no supplements and reassess in two weeks
  4. Provide vitamin C megadoses alone without addressing energy and protein

Explanation

Pressure injury healing increases energy and protein requirements, and guidelines recommend higher protein intake plus supplementation when oral intake is inadequate. Micronutrients support healing but cannot substitute for adequate energy and protein.

Question 41Clinical Nutrition

A patient with advanced chronic kidney disease and a serum potassium of 5.9 mEq/L asks about diet. Which recommendation is most appropriate?

  1. Increase intake of bananas and oranges to improve fiber
  2. Drink more fruit juice to increase fluid intake
  3. Limit high-potassium foods and review medications that raise potassium Correct answer.
  4. Switch to a potassium-based salt substitute

Explanation

Hyperkalemia in CKD is managed by limiting high-potassium foods, reviewing medications such as ACE inhibitors or potassium-sparing diuretics, and addressing metabolic acidosis. Potassium-based substitutes and potassium-rich juices would worsen the problem.

Question 42Clinical Nutrition

A patient with celiac disease is newly diagnosed and asks about oats. Which statement is most accurate?

  1. Oats are safe only if they are the instant variety
  2. Oats are safe because they contain no protein
  3. Pure, uncontaminated oats are generally tolerated by most adults with celiac disease when introduced cautiously Correct answer.
  4. Oats contain gliadin and must be avoided lifelong by all patients with celiac disease

Explanation

Pure oats are not toxic to most patients with celiac disease, but they are frequently cross-contaminated with wheat during milling. Guidelines advise using certified uncontaminated oats and monitoring symptoms and serology.

Question 43Clinical Nutrition

A patient with gout wants dietary advice. Which recommendation is best supported?

  1. Increase organ meat intake to improve iron status
  2. Limit purine-rich organ meats and beer while maintaining adequate hydration Correct answer.
  3. Increase fructose-sweetened beverages to alkalinize urine
  4. Restrict all fluids to reduce uric acid excretion

Explanation

Organ meats and beer are high in purines and are associated with gout flares, and adequate hydration supports uric acid excretion. Fructose-sweetened beverages raise uric acid and should be limited.

Question 44Clinical Nutrition

A patient with decompensated heart failure and hyponatremia is receiving diuretics. Which nutrition approach is most appropriate?

  1. Aggressive free water intake to dilute serum sodium
  2. Potassium supplementation without laboratory monitoring
  3. Moderate fluid restriction and sodium limitation with monitoring of electrolytes and weight Correct answer.
  4. High-sodium diet to replace diuretic losses

Explanation

Hyponatremia in heart failure is often dilutional, so moderate fluid restriction plus sodium limitation and close monitoring of weight and electrolytes is appropriate. Free water worsens dilutional hyponatremia, and unmonitored potassium risks arrhythmia.

Question 45Clinical Nutrition

A patient with severe acute pancreatitis requires nutrition support and cannot tolerate enteral feeding. Which approach is most appropriate?

  1. Start parenteral nutrition on admission before attempting enteral feeding
  2. Keep the patient NPO with intravenous fluids only
  3. Initiate parenteral nutrition after a trial of enteral feeding has failed Correct answer.
  4. Provide a high-fat enteral formula to improve tolerance

Explanation

Enteral nutrition is preferred in acute pancreatitis, and parenteral nutrition is reserved for patients who cannot be fed enterally or who fail to meet needs. A high-fat formula is not the standard choice, and prolonged NPO status is avoided.

Question 46Clinical Nutrition

A patient with chronic kidney disease on hemodialysis has a serum phosphorus of 7.0 mg/dL despite dietary counseling. Which combination is most appropriate?

  1. Limit phosphate additives and high-phosphorus foods while taking phosphate binders with meals Correct answer.
  2. Take phosphate binders on an empty stomach
  3. Increase cola intake to improve hydration
  4. Increase dairy intake to improve calcium absorption

Explanation

Hyperphosphatemia in dialysis is managed by limiting dietary phosphate, especially additives, and taking binders with meals so they bind phosphate in the gut. Colas contain phosphoric acid and worsen phosphorus load.

Question 47Clinical Nutrition

A patient with a new colostomy notices loose output and asks about diet. Which guidance is most appropriate?

  1. Eat small meals and try low-fiber, low-fat foods initially, adding fiber gradually Correct answer.
  2. Increase raw fruits and vegetables immediately to thicken output
  3. Drink large amounts of caffeinated beverages to stimulate regularity
  4. Avoid all fluids for the first week

Explanation

Early after colostomy, a low-fiber, low-fat diet with small meals helps control output, and fiber is added gradually as tolerance improves. Caffeine and large fluid volumes can increase output, and fluid avoidance risks dehydration.

Question 48Clinical Nutrition

A patient with severe malnutrition and a body mass index of 13 kg/m2 is admitted. Which approach best reduces refeeding risk?

  1. Start at full caloric goal immediately to correct malnutrition quickly
  2. Provide only intravenous dextrose to avoid enteral feeding
  3. Withhold all nutrition until electrolytes normalize
  4. Start feeding at a low rate and advance gradually while monitoring phosphate, potassium, and magnesium Correct answer.

Explanation

Refeeding syndrome is prevented by starting at low energy intake and advancing slowly with close monitoring of phosphate, potassium, and magnesium. Rapid full feeding and dextrose-only support precipitate the syndrome.

Question 49Clinical Nutrition

A patient with chronic kidney disease and diabetes has a serum potassium of 6.1 mEq/L. Which action is most appropriate?

  1. Use a potassium-based salt substitute to reduce sodium
  2. Increase intake of oranges and potatoes to improve nutrition
  3. Review medications and dietary potassium sources and consider potassium binders Correct answer.
  4. Restrict protein to 0.4 g/kg/day to lower potassium

Explanation

Hyperkalemia in CKD is managed by identifying medications and dietary sources of potassium, correcting acidosis, and using potassium binders when needed. Potassium-rich foods and salt substitutes worsen hyperkalemia, and severe protein restriction is not the primary treatment.

Question 50Clinical Nutrition

A patient with short bowel syndrome has a jejunostomy and is transitioned from parenteral to enteral nutrition. Which strategy best supports intestinal adaptation?

  1. Provide only clear liquids until adaptation occurs
  2. Restrict oral intake to reduce ostomy output
  3. Provide continuous enteral feeding with gradual advancement and use oral rehydration solutions Correct answer.
  4. Provide bolus hypertonic feeds to stimulate adaptation

Explanation

Intestinal adaptation is supported by continuous enteral feeding that is gradually advanced, along with oral rehydration solutions to maintain sodium and water balance. Hypertonic boluses and oral restriction impair adaptation.