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Clinical Dietitian practice questions

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Question 1Food and Nutrition Sciences

Which macronutrient provides the most energy per gram when metabolized in the body?

  1. Alcohol
  2. Protein
  3. Fat Correct answer.
  4. Carbohydrate

Explanation

Fat yields about 9 kcal per gram, whereas carbohydrate and protein each yield about 4 kcal per gram. Alcohol supplies roughly 7 kcal per gram, so it ranks below fat despite being energy dense.

Question 2Food and Nutrition Sciences

A dietitian is calculating the energy content of a formula providing 60 g carbohydrate, 20 g protein, and 15 g fat per liter. What is the approximate energy density?

  1. 455 kcal/L Correct answer.
  2. 615 kcal/L
  3. 380 kcal/L
  4. 530 kcal/L

Explanation

Using Atwater factors, carbohydrate contributes 60 × 4 = 240 kcal, protein 20 × 4 = 80 kcal, and fat 15 × 9 = 135 kcal. Summing these gives 455 kcal per liter.

Question 3Food and Nutrition Sciences

Which amino acid is classified as conditionally essential because synthesis can become inadequate during critical illness or prematurity?

  1. Leucine
  2. Asparagine
  3. Alanine
  4. Glutamine Correct answer.

Explanation

Glutamine is normally synthesized in adequate amounts but demand can exceed supply during catabolic stress such as critical illness or in premature infants. Leucine, alanine, and asparagine are not classified as conditionally essential in this context.

Question 4Food and Nutrition Sciences

Which vitamin deficiency is most directly associated with impaired carboxylation of clotting factors II, VII, IX, and X?

  1. Vitamin C
  2. Vitamin E
  3. Vitamin B12
  4. Vitamin K Correct answer.

Explanation

Vitamin K is the cofactor for gamma-carboxylation of glutamate residues in clotting factors II, VII, IX, and X. Without adequate vitamin K, these factors cannot bind calcium and clotting is impaired.

Question 5Food and Nutrition Sciences

A patient with chronic kidney disease not on dialysis requires protein intake. Which recommendation aligns with current clinical guidance for a stable non-dialyzed adult?

  1. 1.2 to 1.5 g/kg/day
  2. 0.6 to 0.8 g/kg/day Correct answer.
  3. 2.5 g/kg/day or more
  4. 1.8 to 2.0 g/kg/day

Explanation

For stable, non-dialyzed chronic kidney disease, protein is generally restricted to about 0.6 to 0.8 g/kg/day to reduce nitrogenous waste while maintaining nutritional status. Higher intakes are reserved for dialysis, where protein losses increase.

Question 6Food and Nutrition Sciences

Which laboratory marker is the most specific indicator of recent iron status rather than inflammation-affected storage?

  1. Total iron-binding capacity
  2. Serum iron
  3. Serum ferritin
  4. Soluble transferrin receptor Correct answer.

Explanation

Soluble transferrin receptor reflects iron deficiency at the tissue level and is less affected by inflammation than ferritin. Ferritin is an acute-phase reactant and can be elevated despite iron deficiency during inflammation.

Question 7Food and Nutrition Sciences

Which dietary component most strongly increases non-heme iron absorption when consumed in the same meal?

  1. Calcium
  2. Tannins
  3. Phytate
  4. Vitamin C Correct answer.

Explanation

Vitamin C reduces ferric iron to the more absorbable ferrous form and chelates it, enhancing non-heme iron absorption. Phytates, calcium, and tannins inhibit absorption.

Question 8Food and Nutrition Sciences

In the dietary treatment of celiac disease, which grain is safe to include because it is naturally gluten-free?

  1. Quinoa Correct answer.
  2. Rye
  3. Barley
  4. Spelt

Explanation

Quinoa is a naturally gluten-free pseudocereal suitable for celiac disease. Barley, rye, and spelt all contain gluten proteins that must be avoided.

Question 9Food and Nutrition Sciences

Which condition is most strongly associated with a deficiency of thiamin?

  1. Scurvy
  2. Beriberi Correct answer.
  3. Rickets
  4. Pellagra

Explanation

Thiamin deficiency causes beriberi, affecting cardiac and neurologic function. Pellagra results from niacin deficiency, scurvy from vitamin C deficiency, and rickets from vitamin D deficiency.

Question 10Food and Nutrition Sciences

A patient with advanced cirrhosis has ascites and is prescribed a sodium restriction. Which approach best reflects appropriate nutrition management?

  1. Eliminate fat from the diet to reduce hepatic workload
  2. Restrict all fluids to 500 mL/day regardless of serum sodium
  3. Restrict sodium to about 2 g/day while ensuring adequate protein and energy Correct answer.
  4. Restrict protein to 0.4 g/kg/day to prevent encephalopathy

Explanation

Sodium restriction of roughly 2 g/day helps manage ascites, while adequate protein and energy prevent malnutrition, which worsens outcomes in cirrhosis. Routine severe protein restriction is not recommended because it does not prevent encephalopathy.

Question 11Food and Nutrition Sciences

Which anthropometric measurement is most useful for estimating visceral adiposity and cardiometabolic risk in adults?

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

Explanation

Waist circumference reflects central adiposity and correlates with visceral fat and cardiometabolic risk. The other measurements assess limb or head dimensions and are not markers of central obesity.

Question 12Food and Nutrition Sciences

A patient reports unintentional weight loss of 8% over three months with reduced intake. Which nutrition diagnosis label is most appropriate?

  1. Malnutrition related to insufficient intake Correct answer.
  2. Food-medication interaction
  3. Inadequate protein-energy intake
  4. Overweight/obesity

Explanation

Significant unintentional weight loss with reduced intake meets criteria for malnutrition related to insufficient intake. The diagnosis should reflect the nutrition problem and its etiology, not merely the intake deficit.

Question 13Food and Nutrition Sciences

Which factor most increases resting energy expenditure in a hospitalized patient?

  1. Advanced age
  2. Hypothyroidism
  3. Sedentary activity
  4. Mild fever Correct answer.

Explanation

Fever raises metabolic rate, roughly increasing resting energy expenditure by about 10 to 13 percent per degree Celsius. Aging and hypothyroidism lower energy expenditure, and sedentary activity does not raise resting expenditure.

Question 14Food and Nutrition Sciences

Which fatty acid is classified as an essential omega-3 fatty acid that must be obtained from the diet?

  1. Linoleic acid
  2. Oleic acid
  3. Palmitic acid
  4. Alpha-linolenic acid Correct answer.

Explanation

Alpha-linolenic acid is an essential omega-3 fatty acid because humans lack the desaturase needed to synthesize it. Linoleic acid is essential but is an omega-6 fatty acid.

Question 15Food and Nutrition Sciences

A vegan patient has low serum vitamin B12 and elevated methylmalonic acid. Which food source would reliably correct the deficiency?

  1. Fortified plant milk Correct answer.
  2. Legumes
  3. Spinach
  4. Whole grains

Explanation

Vitamin B12 occurs naturally almost exclusively in animal foods, so vegans depend on fortified products or supplements. Fortified plant milk is a reliable source, whereas spinach, whole grains, and legumes do not supply active B12.

Question 16Food and Nutrition Sciences

Which nutrition intervention is most appropriate first-line for a patient with mild hypertriglyceridemia?

  1. Increase refined carbohydrate intake
  2. Reduce added sugars and refined carbohydrates Correct answer.
  3. Eliminate all dietary fiber
  4. Increase saturated fat intake

Explanation

Reducing added sugars and refined carbohydrates lowers hepatic triglyceride synthesis and is a first-line dietary approach. Increasing refined carbohydrate or saturated fat would worsen the lipid profile.

Question 17Food and Nutrition Sciences

Which electrolyte disturbance is most characteristic of refeeding syndrome in a malnourished patient starting nutrition support?

  1. Hyperkalemia
  2. Hypercalcemia
  3. Hypernatremia
  4. Hypophosphatemia Correct answer.

Explanation

Refeeding syndrome is marked by hypophosphatemia as insulin surges drive phosphate into cells during reintroduction of carbohydrate. Hypokalemia and hypomagnesemia also occur, but phosphate is the hallmark.

Question 18Food and Nutrition Sciences

A dietitian is counseling a patient with lactose intolerance. Which strategy is most appropriate to maintain calcium intake?

  1. Replace dairy with calcium-rich dark green vegetables only
  2. Avoid all dairy products permanently
  3. Increase sodium intake to enhance calcium absorption
  4. Use lactose-reduced dairy or small portions with meals Correct answer.

Explanation

Lactose-reduced dairy or small portions of dairy with meals allow most patients to tolerate lactose while maintaining calcium intake. Complete dairy avoidance risks inadequate calcium unless carefully substituted.

Question 19Food and Nutrition Sciences

Which measure best assesses long-term glycemic control in a patient with diabetes?

  1. Fasting plasma glucose
  2. Hemoglobin A1c Correct answer.
  3. Random capillary glucose
  4. Urine glucose

Explanation

Hemoglobin A1c reflects average glucose over roughly the preceding two to three months. Fasting and random glucose values capture only a single time point.

Question 20Food and Nutrition Sciences

A patient with hypertension is advised to follow the DASH eating pattern. Which change is central to this pattern?

  1. Increasing processed snack foods
  2. Increasing red meat and saturated fat
  3. Eliminating all carbohydrates
  4. Increasing fruits, vegetables, and low-fat dairy while limiting sodium Correct answer.

Explanation

DASH emphasizes fruits, vegetables, whole grains, and low-fat dairy while limiting sodium, saturated fat, and added sugars. This pattern lowers blood pressure in clinical trials.

Question 21Food and Nutrition Sciences

Which statement about dietary fiber and glycemic response is most accurate?

  1. All fibers raise postprandial glucose equally
  2. Soluble fiber slows gastric emptying and blunts postprandial glucose rise Correct answer.
  3. Insoluble fiber has no effect on transit time
  4. Fiber increases glycemic index of foods

Explanation

Soluble fiber forms a gel that slows gastric emptying and glucose absorption, reducing postprandial glucose excursions. Insoluble fiber mainly adds bulk and speeds transit.

Question 22Food and Nutrition Sciences

Which nutrient is most likely to be inadequate in a patient following a strict long-term ketogenic diet without supplementation?

  1. Fiber Correct answer.
  2. Sodium
  3. Vitamin C
  4. Vitamin B12

Explanation

Very-low-carbohydrate ketogenic diets restrict fruits, whole grains, and legumes, which are major fiber sources, so fiber intake often falls short. Vitamin C can be met by low-carbohydrate vegetables, and B12 is unaffected in omnivores.

Question 23Food and Nutrition Sciences

A patient with a new ileostomy has high-output losses. Which nutrition strategy best supports fluid and electrolyte balance?

  1. Encourage oral rehydration solution and sodium-rich foods between meals Correct answer.
  2. Increase simple sugars to promote absorption
  3. Encourage fluids with meals and a high-fiber diet
  4. Restrict all fluids to reduce output

Explanation

High-output ileostomies cause sodium and water losses, so oral rehydration solutions and sodium-rich foods taken between meals help maintain balance. Large fluid volumes with meals can worsen output.

Question 24Food and Nutrition Sciences

Which population group has the highest recommended dietary allowance for calcium to support peak bone mass?

  1. Pregnant women in the first trimester
  2. Older adults over 70 years
  3. Adolescents Correct answer.
  4. Young children

Explanation

Adolescents have the highest calcium requirement, about 1,300 mg/day, because rapid skeletal growth demands high calcium accretion. Older adults need about 1,200 mg/day, and younger children need less.

Question 25Food and Nutrition Sciences

A dietitian is evaluating a patient with suspected food allergy. Which approach is most appropriate before recommending an elimination diet?

  1. Confirm the diagnosis with allergy testing and a supervised elimination trial Correct answer.
  2. Rely on patient self-report alone
  3. Remove all major allergens simultaneously for six months
  4. Recommend a rotation diet without testing

Explanation

Elimination diets carry nutritional risk, so the diagnosis should be confirmed with appropriate allergy testing and a supervised trial before long-term removal of foods. Removing all allergens simultaneously can cause malnutrition and is not diagnostic.

Question 26Food and Nutrition Sciences

A 30-year-old woman with newly diagnosed celiac disease asks which grain is safe to include in her diet without causing intestinal damage. Which grain is naturally gluten-free?

  1. Barley
  2. Wheat
  3. Quinoa Correct answer.
  4. Rye

Explanation

Celiac disease requires strict avoidance of gluten, which is found in wheat, barley, rye, and their derivatives. Quinoa is a pseudocereal that is naturally gluten-free and can be safely included in a gluten-free diet. Therefore, quinoa is the appropriate choice.

Question 27Food and Nutrition Sciences

A 45-year-old man with type 2 diabetes and a BMI of 32 kg/m² is counseled on dietary strategies to improve glycemic control. Which dietary approach is most strongly supported by evidence for reducing HbA1c?

  1. Following a Mediterranean-style eating pattern Correct answer.
  2. Increasing intake of refined carbohydrates
  3. Skipping breakfast regularly
  4. Consuming a very low-fat diet high in simple sugars

Explanation

A Mediterranean-style eating pattern, rich in vegetables, fruits, whole grains, legumes, nuts, and olive oil, has been shown in randomized trials to improve glycemic control and reduce HbA1c in type 2 diabetes. Refined carbohydrates and simple sugars can worsen glycemia, and regular breakfast skipping is not an evidence-based strategy for glycemic improvement.

Question 28Food and Nutrition Sciences

A 60-year-old woman with chronic kidney disease stage 4 (eGFR 25 mL/min/1.73 m²) has a serum potassium of 5.8 mmol/L. Which dietary instruction is most appropriate to help lower her potassium intake?

  1. Drink more fruit juices
  2. Limit intake of high-potassium foods such as potatoes, tomatoes, and bananas Correct answer.
  3. Use salt substitutes containing potassium chloride
  4. Increase consumption of bananas and oranges

Explanation

In chronic kidney disease, reduced renal potassium excretion can lead to hyperkalemia. Limiting high-potassium foods such as potatoes, tomatoes, bananas, and oranges is a standard dietary approach to lower potassium intake. Salt substitutes containing potassium chloride and fruit juices are typically high in potassium and should be avoided.

Question 29Food and Nutrition Sciences

A 55-year-old man with acute pancreatitis is admitted with severe abdominal pain and vomiting. He is hemodynamically stable. According to current guidelines, which nutrition intervention is most appropriate for this patient?

  1. Provide a clear liquid diet and advance as tolerated
  2. Start enteral nutrition with a low-fat formula via nasogastric tube within 24-48 hours Correct answer.
  3. Initiate parenteral nutrition immediately
  4. Keep patient NPO for at least 7 days

Explanation

Current guidelines recommend early enteral nutrition, preferably within 24-48 hours, in patients with acute pancreatitis who are hemodynamically stable and cannot eat orally. Enteral nutrition helps maintain gut integrity and reduces complications compared with parenteral nutrition or prolonged fasting. A low-fat formula is typically used to minimize pancreatic stimulation.

Question 30Food and Nutrition Sciences

A 62-year-old man with type 2 diabetes and a history of atrial fibrillation asks whether his usual dietary intake of fatty fish is safe. He eats salmon twice weekly and takes warfarin, with a stable INR of 2.4. Which counseling statement best reflects appropriate nutrition guidance?

  1. Continue the fish intake at a consistent weekly amount, since maintaining a stable vitamin K and overall dietary pattern supports INR stability. Correct answer.
  2. Increase intake to daily fatty fish to replace warfarin anticoagulation through antiplatelet effects.
  3. Eliminate all fish from the diet because the omega-3 content directly antagonizes warfarin and raises INR.
  4. Add a high-dose fish oil supplement and stop monitoring INR, because supplements do not interact with warfarin.

Explanation

Warfarin's effect is determined by vitamin K intake and overall dietary consistency, so patients are generally advised to keep intake of vitamin K-rich foods, including fish and green vegetables, steady rather than eliminate them. Fatty fish is a reasonable part of a cardiometabolic diet and does not require avoidance when INR is stable. High-dose supplements and self-discontinuation of monitoring are unsafe because they can alter anticoagulant effect.

Question 31Nutrition Care Process and Assessment

During a nutrition-focused physical exam, a dietitian observes bilateral pitting edema extending above the knees with skin that remains indented for several seconds. Which grading best describes this finding?

  1. 2+ edema
  2. 1+ edema
  3. 3+ edema
  4. 4+ edema Correct answer.

Explanation

Standard edema grading uses depth and duration of the pit plus the anatomic extent of swelling. 4+ describes a very deep pit that persists for a prolonged period (often minutes) with swelling extending well above the knee or involving the entire limb.

Question 32Nutrition Care Process and Assessment

A patient's mid-upper arm circumference is measured at 22 cm with triceps skinfold indicating preserved fat stores. Which interpretation is most appropriate?

  1. Findings are invalid because MUAC cannot be used in adults
  2. Findings confirm adequate protein status and require no follow-up
  3. Findings indicate isolated fat-soluble vitamin deficiency
  4. Findings suggest reduced skeletal muscle mass and warrant further assessment Correct answer.

Explanation

Low MUAC with relatively preserved triceps skinfold points toward muscle depletion rather than fat loss. Because MUAC reflects both fat and lean tissue, it should be interpreted alongside other measures and prompts further evaluation of muscle mass and function.

Question 33Nutrition Care Process and Assessment

Which laboratory value is most directly used to estimate visceral protein status in the nutrition assessment of a hospitalized adult?

  1. Serum alkaline phosphatase
  2. Serum potassium
  3. Serum prealbumin (transthyretin) Correct answer.
  4. Hemoglobin

Explanation

Transthyretin (prealbumin) is a short-half-life visceral protein historically used as a marker of protein status and response to nutrition support. It is influenced by inflammation and should be interpreted cautiously rather than as a stand-alone indicator.

Question 34Nutrition Care Process and Assessment

A dietitian calculates a patient's 24-hour urea nitrogen excretion and finds it markedly elevated relative to nitrogen intake. Which conclusion is best supported?

  1. The patient has isolated vitamin B12 deficiency
  2. The patient is in negative nitrogen balance with catabolism Correct answer.
  3. The patient is in positive nitrogen balance with anabolism
  4. The patient has excessive dietary fiber intake

Explanation

Nitrogen balance compares nitrogen intake with nitrogen excretion, mainly urinary urea nitrogen plus insensible losses. When excretion greatly exceeds intake, the patient is catabolic and in negative nitrogen balance.

Question 35Nutrition Care Process and Assessment

Which statement best describes the purpose of the nutrition diagnosis step within the Nutrition Care Process?

  1. It finalizes reimbursement coding for the hospital stay
  2. It replaces the medical diagnosis recorded in the chart
  3. It documents the specific nutrition problem using standardized terminology to guide intervention Correct answer.
  4. It records only the patient's food preferences

Explanation

The nutrition diagnosis identifies and labels a specific nutrition problem using standardized terms (problem, etiology, signs and symptoms). It creates a focused statement that directs the selection of nutrition interventions and later monitoring.

Question 36Nutrition Care Process and Assessment

A patient reports unintentional weight loss of 8% over the past 3 months with reduced intake due to poor appetite. Which PES statement is best constructed?

  1. Malnutrition related to weight loss as evidenced by poor appetite
  2. Inadequate oral intake related to decreased appetite as evidenced by 8% weight loss in 3 months Correct answer.
  3. Decreased appetite related to malnutrition as evidenced by 8% weight loss
  4. Weight loss related to inadequate oral intake as evidenced by decreased appetite

Explanation

A PES statement pairs a standardized nutrition problem with its etiology (related to) and supporting signs and symptoms (as evidenced by). Inadequate oral intake is the problem, decreased appetite the cause, and documented weight loss the evidence.

Question 37Nutrition Care Process and Assessment

Which anthropometric index is most appropriate for classifying nutritional status in a healthy 6-year-old child?

  1. Triceps skinfold percentile alone
  2. Body mass index-for-age percentile Correct answer.
  3. Mid-upper arm circumference alone
  4. Waist-to-hip ratio

Explanation

In children, BMI must be interpreted against age- and sex-specific growth references; BMI-for-age percentile is the standard screening index for underweight and overweight. Single circumference or skinfold measures lack the same validated cutoffs for pediatric classification.

Question 38Nutrition Care Process and Assessment

A patient with chronic kidney disease has a serum albumin of 2.9 g/dL. Which factor most limits using this value as proof of protein-energy malnutrition?

  1. Inflammation and fluid status can lower albumin independent of intake Correct answer.
  2. Albumin is measured only in urine
  3. Albumin has a half-life of only a few hours
  4. Albumin reflects iron stores rather than protein

Explanation

Albumin is a negative acute-phase reactant, so inflammation, infection, and fluid shifts reduce serum levels regardless of nutrient intake. A low value therefore cannot by itself confirm malnutrition and should be interpreted with inflammatory status and clinical findings.

Question 39Nutrition Care Process and Assessment

Which screening tool was developed specifically for hospitalized adults and combines recent weight loss, intake, and disease severity?

  1. Nutrition Risk Screening 2002 (NRS-2002) Correct answer.
  2. Subjective Global Assessment (SGA)
  3. Mini Nutritional Assessment (MNA)
  4. Malnutrition Universal Screening Tool (MUST)

Explanation

NRS-2002 was designed for hospitalized patients and scores nutritional status plus disease severity. It is widely recommended for inpatient screening to identify those who may benefit from nutrition support.

Question 40Nutrition Care Process and Assessment

During a 24-hour recall, a patient cannot accurately report portions. Which approach best improves the validity of the diet history?

  1. Ask the patient to estimate portions using household measures and food models Correct answer.
  2. Accept the recall without probing because recall is inherently accurate
  3. Record only the foods the patient enjoys most
  4. Replace the recall with a single serum nutrient level

Explanation

Portion estimation is a major source of error in recall methods. Using household measures, food models, or pictures helps patients quantify intake more accurately and improves the validity of the estimated nutrient intake.

Question 41Nutrition Care Process and Assessment

A dietitian suspects the patient has been underreporting energy intake on food records. Which finding would most support this concern?

  1. Reported intake is implausibly low relative to estimated resting energy expenditure Correct answer.
  2. The record lists brand names of foods
  3. The record includes weekend days
  4. Reported intake matches measured energy expenditure closely

Explanation

Underreporting is suggested when reported energy intake falls well below what is physiologically plausible given estimated or measured expenditure. Comparing reported intake with expenditure helps flag implausible records.

Question 42Nutrition Care Process and Assessment

Which measure is the most appropriate single indicator of central adiposity in a nutrition assessment?

  1. Waist circumference Correct answer.
  2. Wrist circumference
  3. Calf circumference
  4. Hip circumference

Explanation

Waist circumference reflects abdominal fat distribution and is associated with cardiometabolic risk. It is used alongside BMI to characterize central adiposity.

Question 43Nutrition Care Process and Assessment

An older adult in long-term care has unintentional weight loss and reduced food intake. Which tool is specifically designed to assess nutritional status in this population?

  1. Mini Nutritional Assessment (MNA) Correct answer.
  2. NRS-2002
  3. MUST
  4. Cornell Medical Index

Explanation

The MNA was developed and validated for older adults and includes anthropometric, dietary, and general assessment items. It is widely used in geriatric and long-term care settings to identify malnutrition risk.

Question 44Nutrition Care Process and Assessment

A patient's handgrip strength is markedly reduced while BMI is normal. What does this finding most likely suggest?

  1. Excess visceral fat requiring no further evaluation
  2. Reduced muscle function consistent with possible sarcopenia Correct answer.
  3. Isolated iron deficiency anemia
  4. Normal nutritional status with no concern

Explanation

Handgrip strength is a functional measure of muscle strength and a criterion in sarcopenia assessment. Low strength with normal BMI suggests reduced muscle function and warrants further evaluation of muscle mass and nutrition status.

Question 45Nutrition Care Process and Assessment

Which statement about the Subjective Global Assessment (SGA) is accurate?

  1. It relies solely on serum albumin and prealbumin
  2. It classifies patients as well nourished, moderately malnourished, or severely malnourished based on history and physical exam Correct answer.
  3. It quantifies energy expenditure by indirect calorimetry
  4. It is a laboratory-only screening test

Explanation

SGA combines a structured history (weight change, intake, symptoms) with physical findings (muscle, fat, edema) to assign a global nutrition category. It does not depend on laboratory values.

Question 46Nutrition Care Process and Assessment

A dietitian is estimating energy needs for a critically ill patient. Which approach is generally recommended as the initial method when indirect calorimetry is unavailable?

  1. Use 10 kcal/kg body weight for all patients
  2. Use the patient's reported dietary intake as the energy target
  3. Use a validated predictive equation such as Mifflin-St Jeor or Penn State Correct answer.
  4. Use 50 kcal/kg body weight routinely

Explanation

When indirect calorimetry is not available, validated predictive equations are recommended, with the choice depending on patient characteristics such as obesity or critical illness. Extreme fixed multipliers are not appropriate as routine initial estimates.

Question 47Nutrition Care Process and Assessment

Which finding during nutrition-focused physical exam best supports depletion of subcutaneous fat stores?

  1. Sunken temporal regions and prominent ribs with loss of fat over the triceps Correct answer.
  2. Bilateral ankle edema
  3. Angular stomatitis at the mouth corners
  4. Spoon-shaped nails

Explanation

Loss of subcutaneous fat is assessed by inspecting areas such as the temporal region, triceps, and ribs for hollowing or prominence. These findings indicate fat depletion rather than fluid or micronutrient changes.

Question 48Nutrition Care Process and Assessment

Which laboratory parameter is most useful for monitoring short-term response to nutrition support in a patient without significant inflammation?

  1. Serum transthyretin (prealbumin) Correct answer.
  2. Serum creatinine
  3. Serum sodium
  4. Serum bilirubin

Explanation

Transthyretin has a short half-life of about 2 days, so it can change more rapidly than albumin and is used to monitor short-term response. Its usefulness is limited when inflammation is present.

Question 49Nutrition Care Process and Assessment

A patient's indirect calorimetry shows a respiratory quotient of 1.05. Which interpretation is most appropriate?

  1. Findings indicate predominant fat oxidation
  2. Findings suggest net lipogenesis and possible overfeeding with carbohydrate Correct answer.
  3. Findings indicate the patient is fasting
  4. Findings confirm measurement error and should be discarded

Explanation

A respiratory quotient above 1.0 indicates net fat synthesis, often from excess carbohydrate intake relative to needs. It prompts review of the feeding regimen for possible overfeeding.

Question 50Nutrition Care Process and Assessment

Which element of the nutrition assessment best captures a patient's ability to obtain and prepare food?

  1. Resting energy expenditure
  2. Serum electrolyte panel
  3. Food and nutrition-related history including food security and access Correct answer.
  4. Triceps skinfold measurement

Explanation

The food and nutrition-related history domain includes food security, access, shopping, and cooking ability. These factors influence whether a nutrition plan can be followed.