TheoryRegistered Dietitian
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30 free Registered Dietitian questions
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Clinical Nutrition
Which anthropometric measurement is most commonly used to assess body fat distribution and cardiovascular disease risk?
Correct — C. Waist circumference reflects visceral adiposity and is the most widely used anthropometric marker for cardiovascular and metabolic disease risk. BMI reflects total weight relative to height but does not distinguish fat distribution. -
Clinical Nutrition
Which laboratory value is considered the best single marker of long-term glycemic control in patients with diabetes?
Correct — A. HbA1c reflects average blood glucose over approximately 2–3 months and is the gold standard for monitoring long-term glycemic control. Fasting glucose and postprandial glucose are point-in-time measurements. -
Clinical Nutrition
The Subjective Global Assessment (SGA) classifies nutritional status into which categories?
Correct — B. SGA uses clinical judgment incorporating history and physical findings to classify patients as A (well-nourished), B (moderately malnourished), or C (severely malnourished). It does not use a four-tier system. -
Clinical Nutrition
A hospitalized patient has a serum albumin of 2.8 g/dL. Which factor most limits the interpretation of albumin as a nutritional marker in this patient?
Correct — D. Albumin is a negative acute-phase protein; inflammation, stress, and illness suppress its synthesis and cause fluid shifts that lower serum levels independently of nutritional intake. Its 20-day half-life makes it a poor marker of short-term nutrition changes as well. -
Clinical Nutrition
According to the 2012 ASPEN/AND consensus definitions, which combination of criteria is required to diagnose malnutrition in adults in the context of chronic illness?
Correct — A. The 2012 ASPEN/AND consensus framework requires inadequate energy intake plus at least one of five physical findings: weight loss, loss of muscle, loss of subcutaneous fat, fluid accumulation, or diminished functional status. Lab values alone do not diagnose malnutrition under this framework. -
Clinical Nutrition
Which equation is most commonly used in clinical practice to estimate resting metabolic rate (RMR) in adults?
Correct — B. The Mifflin-St Jeor equation has been validated as the most accurate predictive equation for RMR in normal-weight and obese adults. Harris-Benedict was historically dominant but overestimates RMR in obese individuals. -
Clinical Nutrition
A 70 kg critically ill patient is mechanically ventilated. Which method provides the most accurate measurement of energy expenditure in this patient?
Correct — C. Indirect calorimetry directly measures oxygen consumption and carbon dioxide production to calculate energy expenditure and is the gold standard for critically ill patients, in whom predictive equations are especially inaccurate. -
Clinical Nutrition
A non-obese critically ill patient (BMI 24, weight 75 kg) is in the acute phase of illness. What initial energy target do current ASPEN/SCCM guidelines recommend?
Correct — D. ASPEN/SCCM guidelines for non-obese critically ill adults recommend advancing to 25–30 kcal/kg/day (actual body weight) over the first 24–48 hours. Starting at full repletion immediately is not recommended due to refeeding and tolerance concerns. -
Clinical Nutrition
What is the recommended protein intake (g/kg/day actual body weight) for a critically ill adult without renal or hepatic failure?
Correct — A. Current ASPEN/SCCM guidelines recommend 1.2–2.0 g/kg/day of protein for most critically ill patients to attenuate lean body mass loss and support recovery. The RDA of 0.8 g/kg is for healthy adults and is insufficient in critical illness. -
Clinical Nutrition
For a morbidly obese patient (BMI > 40) requiring EN support in the ICU, ASPEN recommends estimating protein needs based on which weight?
Correct — B. ASPEN recommends using ideal body weight for protein calculations in morbidly obese ICU patients, targeting 2.0–2.5 g/kg IBW/day to preserve lean mass during hypocaloric feeding. Actual body weight overestimates needs due to excess adipose tissue. -
Clinical Nutrition
A patient receiving parenteral nutrition is prescribed 900 kcal from dextrose, 450 kcal from lipid emulsion, and 225 kcal from amino acids per day. What is the non-protein calorie-to-nitrogen (NPC:N) ratio?
Correct — C. Non-protein calories = dextrose + lipid = 900 + 450 = 1,350 kcal. Amino acid kcal = 225; protein grams = 225 ÷ 4 = 56.25 g; nitrogen = 56.25 ÷ 6.25 = 9 g. NPC:N = 1,350 ÷ 9 = 150:1. A ratio of 100–150:1 is typical for non-catabolic patients; a lower ratio (more nitrogen-rich) is used in hypercatabolic states. -
Clinical Nutrition
Which enteral feeding access is preferred for long-term tube feeding in a patient with a functional GI tract but inadequate oral intake?
Correct — D. PEG tubes are preferred for long-term enteral nutrition (>4 weeks) because they are more comfortable, lower aspiration risk, and allow the patient greater mobility than nasogastric tubes, which are suitable for short-term use only. -
Clinical Nutrition
A patient receiving continuous gastric tube feeds develops high gastric residual volumes (>500 mL) with no other signs of intolerance. Which intervention is most appropriate as a first step?
Correct — A. Current ASPEN guidelines suggest that gastric residual volumes alone are not sufficient reason to discontinue enteral feeds. A promotility agent is the recommended first-line intervention to improve gastric emptying. Switching to PN should be reserved for confirmed intolerance. -
Clinical Nutrition
Which type of enteral formula is most appropriate for a patient with impaired fat digestion secondary to chronic pancreatitis?
Correct — B. Semi-elemental formulas contain partially hydrolyzed protein and MCTs, which are absorbed directly via the portal system without requiring pancreatic lipase, making them appropriate for fat malabsorption in chronic pancreatitis. -
Clinical Nutrition
An ICU patient with acute respiratory distress syndrome (ARDS) is being considered for a high-fat, low-carbohydrate enteral formula to reduce CO₂ production. Current ASPEN/SCCM guidelines recommend:
Correct — C. Updated ASPEN/SCCM critical care nutrition guidelines do not recommend specialty high-fat low-carbohydrate pulmonary formulas for ARDS. Evidence does not support clinical benefit, and ensuring adequate calories with a standard formula is the priority. -
Clinical Nutrition
Which central venous access site is preferred for long-term parenteral nutrition (PN) administration to reduce infection risk?
Correct — A. Tunneled catheters (e.g., Hickman) and PICCs are preferred for long-term PN because they have lower rates of catheter-related bloodstream infections compared to non-tunneled central catheters. Femoral access carries the highest infection risk. -
Clinical Nutrition
When initiating parenteral nutrition in a severely malnourished patient, which electrolyte abnormality should be most carefully monitored due to refeeding syndrome risk?
Correct — D. Refeeding syndrome is characterized by a shift of phosphate, potassium, and magnesium into cells when anabolism resumes. Hypophosphatemia is the hallmark and most dangerous complication, potentially causing cardiac arrhythmias, respiratory failure, and neuromuscular dysfunction. -
Clinical Nutrition
A patient on home PN develops elevated alkaline phosphatase, total bilirubin, and GGT after 6 weeks. The most likely diagnosis is:
Correct — B. IFALD (formerly PN-associated liver disease) occurs in patients on long-term PN, characterized by cholestasis reflected by elevated bilirubin, ALP, and GGT. Risk factors include lack of enteral stimulation, excessive calories, and lipid emulsion type/dose. -
Clinical Nutrition
To minimize the risk of IFALD in a patient who has been on PN for >3 months, which lipid emulsion strategy is currently best supported by evidence?
Correct — A. Fish-oil–enriched mixed lipid emulsions (SMOF: soybean, MCT, olive, fish oil) provide anti-inflammatory omega-3 fatty acids and reduce phytosterol load compared to pure soybean oil, with evidence supporting reduction in IFALD biomarkers. Doses ≤1 g/kg/day limit excess omega-6 accumulation. -
Clinical Nutrition
What is the recommended protein intake for a non-dialysis chronic kidney disease (CKD) patient at stage 3–4 to slow disease progression?
Correct — C. KDOQI and KDIGO guidelines recommend a low-protein diet of 0.6–0.8 g/kg/day for CKD stages 3–4 patients not on dialysis to reduce uremic toxin accumulation and potentially slow GFR decline. Higher intakes accelerate glomerular hyperfiltration. -
Clinical Nutrition
A hemodialysis patient has persistent hyperkalemia. Which dietary intervention is most effective?
Correct — D. Dietary potassium restriction to 2,000–3,000 mg/day is the primary dietary intervention for hyperkalemia in dialysis patients. Leaching (boiling and draining vegetables) further reduces potassium content. Phosphorus and fluid restrictions address separate but concurrent issues. -
Clinical Nutrition
A patient on continuous renal replacement therapy (CRRT) has increased protein losses. What is the recommended protein target for this patient?
Correct — B. CRRT causes significant amino acid losses in the effluent (approximately 10–15 g/day). ASPEN guidelines recommend 1.5–2.5 g/kg/day to compensate for these losses and meet the elevated demands of critical illness superimposed on renal failure. -
Clinical Nutrition
A patient with cirrhosis and hepatic encephalopathy asks about protein intake. Which statement best reflects current evidence-based recommendations?
Correct — A. Current guidelines no longer support protein restriction for hepatic encephalopathy, as it worsens sarcopenia and outcomes. A target of 1.2–1.5 g/kg/day is recommended. Branched-chain amino acids may help in refractory encephalopathy, and vegetable/dairy protein may be better tolerated. -
Clinical Nutrition
Which vitamin deficiency is most commonly seen in patients with alcoholic liver disease due to impaired hepatic storage and activation?
Correct — C. Thiamine deficiency is the most clinically critical micronutrient deficiency in alcoholic liver disease, caused by poor dietary intake, impaired absorption, and reduced hepatic storage. It can lead to Wernicke encephalopathy and must be repleted before glucose administration. -
Clinical Nutrition
A patient with decompensated cirrhosis and ascites is found to have hyponatremia (serum Na 128 mEq/L). The ascites is managed with diuretics. Regarding sodium in the diet:
Correct — D. EASL and AASLD guidelines recommend a moderate sodium restriction of ~2,000 mg/day (88 mEq/day) in cirrhotic patients with ascites. Severe restriction (<500 mg) is poorly tolerated, reduces palatability, and impairs nutritional intake without additional benefit. The hyponatremia is dilutional and managed with fluid restriction, not sodium supplementation. -
Clinical Nutrition
According to the ADA Standards of Medical Care, what is the recommended HbA1c target for most non-pregnant adults with type 2 diabetes?
Correct — B. The ADA recommends an HbA1c goal of <7.0% for most non-pregnant adults with type 2 diabetes to reduce microvascular complications. Less stringent goals (e.g., <8%) may be appropriate for patients with hypoglycemia unawareness or limited life expectancy. -
Clinical Nutrition
A patient with type 1 diabetes is using an insulin-to-carbohydrate ratio. If her ratio is 1 unit per 15 g of carbohydrate, how many units of rapid-acting insulin should she take for a meal containing 75 g of carbohydrate?
Correct — A. Insulin dose = carbohydrate grams ÷ carbohydrate:insulin ratio = 75 ÷ 15 = 5 units. This calculation is foundational to medical nutrition therapy for type 1 diabetes using carbohydrate counting. -
Clinical Nutrition
Which dietary pattern has the strongest evidence for improving glycemic control and cardiometabolic risk in individuals with type 2 diabetes?
Correct — D. The Mediterranean diet has the most robust evidence base for improving HbA1c, blood pressure, lipids, and cardiovascular outcomes in type 2 diabetes. Multiple large RCTs (including PREDIMED) and meta-analyses support its benefit. -
Clinical Nutrition
A hospitalized patient with type 2 diabetes on tube feeding is receiving a formula providing 50% of calories from carbohydrate. His blood glucose levels are 180–220 mg/dL despite basal-bolus insulin. Which formula change is most evidence-supported?
Correct — C. Diabetes-specific enteral formulas are lower in carbohydrate and higher in monounsaturated fat and fiber, which attenuates postprandial glycemic excursions. Evidence supports their use in reducing blood glucose and insulin requirements in hospitalized patients with hyperglycemia on tube feeding. -
Clinical Nutrition
According to the 2019 ACC/AHA cardiovascular risk reduction guidelines, which dietary pattern is most strongly recommended to reduce ASCVD risk?
Correct — A. The 2019 ACC/AHA guidelines recommend a dietary pattern emphasizing plant foods, whole grains, lean protein, and limiting saturated and trans fats to reduce ASCVD risk. No single macronutrient target (ketogenic, high-protein, very low-fat) is endorsed at the expense of diet quality.
Registered Dietitian sample questions
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Clinical Nutrition A patient with stage 1 hypertension (BP 135/85) is not on medication. Which dietary intervention has the most evidence for reducing blood pressure?
A. Low-fat diet with <20% calories from fat
B. DASH diet combined with sodium restriction to 1,500 mg/day ✓
C. High-potassium supplement alone
D. Vegetarian diet eliminating all animal products
Correct — B. The DASH diet (high in fruits, vegetables, low-fat dairy, reduced saturated fat) combined with sodium restriction to 1,500 mg/day produces the greatest blood pressure reductions in clinical trials. The DASH-Sodium trial demonstrated that the combined approach is more effective than either intervention alone.
Community Nutrition Which method is most commonly used to assess the nutritional needs of a community by collecting data on what individuals actually eat?
A. 24-hour dietary recall ✓
B. Food frequency questionnaire administered once
C. Biochemical blood panel
D. Anthropometric measurements only
Correct — A. The 24-hour dietary recall is the most commonly used method for estimating usual dietary intake at the population level. It provides detailed, quantitative food intake data for the previous 24 hours and is widely used in national surveys.
Foodservice Systems Which type of foodservice system produces meals in a central kitchen and transports them to satellite locations for service?
A. Conventional system
B. Commissary system ✓
C. Ready-prepared system
D. Assembly-serve system
Correct — B. A commissary system centralizes production and distributes meals to satellite or remote service sites. This contrasts with a conventional system where food is both produced and served in the same facility.
Registered Dietitian In a conventional foodservice system, food is:
A. Prepared and served in the same facility on the same day ✓
B. Prepared centrally and shipped frozen to sites
C. Purchased fully cooked and only reheated
D. Cooked, chilled, stored, and reheated later
Correct — A. The conventional system is the traditional model where food is prepared and served at the same location within a short time frame, requiring full on-site production capability.
Management Which type of organizational structure groups employees by function (e.g., nutrition, food production, purchasing) under specialized department heads?
A. Matrix structure
B. Divisional structure
C. Functional structure ✓
D. Flat structure
Correct — C. A functional structure organizes employees by specialty or function, each under a department head with expertise in that area. This promotes efficiency and specialization within each function.
Metabolism Which component typically accounts for the largest portion of total daily energy expenditure in a sedentary adult?
A. Thermic effect of food
B. Physical activity level
C. Basal metabolic rate ✓
D. Adaptive thermogenesis
Correct — C. Basal metabolic rate (BMR) accounts for approximately 60–75% of total daily energy expenditure in sedentary individuals. The thermic effect of food is ~10% and physical activity is variable but typically lower in sedentary people.
Nutrition Care Process Which anthropometric measurement is most commonly used to classify obesity in adults?
A. Waist-to-hip ratio
B. Mid-arm muscle circumference
C. Body mass index (BMI) ✓
D. Triceps skinfold thickness
Correct — C. BMI (kg/m²) is the standard screening tool for classifying underweight, normal weight, overweight, and obesity in adults. A BMI ≥30 kg/m² is classified as obesity by major clinical guidelines.
Nutrition Science How many kilocalories per gram does dietary fat provide?
A. 4 kcal/g
B. 5 kcal/g
C. 9 kcal/g ✓
D. 7 kcal/g
Correct — C. Dietary fat provides 9 kcal per gram, which is more than twice the energy density of carbohydrates or protein (each 4 kcal/g). Alcohol provides 7 kcal/g but is not a macronutrient.
About the Registered Dietitian test
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Nutrition Science, Metabolism, Nutrition Care Process, Clinical Nutrition, Community Nutrition, Foodservice Systems — and more.
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You will be tested on
- Safe and effective care environment
- Health promotion and maintenance
- Psychosocial and physiological integrity
- Pharmacology, infection control and patient safety
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Topics in this question bank
Safe and effective care environment
Health promotion and maintenance
Psychosocial and physiological integrity
Pharmacology, infection control and patient safety
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