Registered Dietitian Exam Questions & Answers 2026 (11–20)

Question 1

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?

TheoryPractice · Accepted Answer

150:1. 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.

Question 2

Which enteral feeding access is preferred for long-term tube feeding in a patient with a functional GI tract but inadequate oral intake?

TheoryPractice · Accepted Answer

Percutaneous endoscopic gastrostomy (PEG). 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.

Question 3

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?

TheoryPractice · Accepted Answer

Administer a promotility agent such as metoclopramide and continue feeds. 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.

Question 4

Which type of enteral formula is most appropriate for a patient with impaired fat digestion secondary to chronic pancreatitis?

TheoryPractice · Accepted Answer

Semi-elemental formula containing medium-chain triglycerides (MCTs). 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.

Question 5

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:

TheoryPractice · Accepted Answer

This formula is NOT recommended; instead, standard formula at goal rate is preferred. 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.

Question 6

Which central venous access site is preferred for long-term parenteral nutrition (PN) administration to reduce infection risk?

TheoryPractice · Accepted Answer

Peripherally inserted central catheter (PICC) or tunneled central venous catheter. 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.

Question 7

When initiating parenteral nutrition in a severely malnourished patient, which electrolyte abnormality should be most carefully monitored due to refeeding syndrome risk?

TheoryPractice · Accepted Answer

Hypophosphatemia. 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.

Question 8

A patient on home PN develops elevated alkaline phosphatase, total bilirubin, and GGT after 6 weeks. The most likely diagnosis is:

TheoryPractice · Accepted Answer

Intestinal failure–associated liver disease (IFALD). 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.

Question 9

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?

TheoryPractice · Accepted Answer

Use a mixed-oil (SMOF) or fish-oil–enriched lipid emulsion at ≤1 g/kg/day. 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.

Question 10

What is the recommended protein intake for a non-dialysis chronic kidney disease (CKD) patient at stage 3–4 to slow disease progression?

TheoryPractice · Accepted Answer

0.6–0.8 g/kg/day. 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.

Registered Dietitian Exam Questions & Answers 2026 (11–20)

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