Registered Dietitian Exam Questions & Answers 2026 (21–30)

Question 1

A hemodialysis patient has persistent hyperkalemia. Which dietary intervention is most effective?

TheoryPractice · Accepted Answer

Restrict dietary potassium to 2,000–3,000 mg/day and leach high-potassium vegetables. 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.

Question 2

A patient on continuous renal replacement therapy (CRRT) has increased protein losses. What is the recommended protein target for this patient?

TheoryPractice · Accepted Answer

1.5–2.5 g/kg/day to compensate for amino acid losses in the effluent. 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.

Question 3

A patient with cirrhosis and hepatic encephalopathy asks about protein intake. Which statement best reflects current evidence-based recommendations?

TheoryPractice · Accepted Answer

Protein restriction is NOT recommended; 1.2–1.5 g/kg/day is advised. 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.

Question 4

Which vitamin deficiency is most commonly seen in patients with alcoholic liver disease due to impaired hepatic storage and activation?

TheoryPractice · Accepted Answer

Thiamine (vitamin B1). 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.

Question 5

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:

TheoryPractice · Accepted Answer

Restrict dietary sodium to 2,000 mg (88 mEq)/day as a moderate restriction to aid ascites management. 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.

Question 6

According to the ADA Standards of Medical Care, what is the recommended HbA1c target for most non-pregnant adults with type 2 diabetes?

TheoryPractice · Accepted Answer

< 7.0%. 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.

Question 7

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?

TheoryPractice · Accepted Answer

5 units. 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.

Question 8

Which dietary pattern has the strongest evidence for improving glycemic control and cardiometabolic risk in individuals with type 2 diabetes?

TheoryPractice · Accepted Answer

Mediterranean-style diet. 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.

Question 9

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?

TheoryPractice · Accepted Answer

Switch to a diabetes-specific formula with lower carbohydrate and higher MUFA/fiber content. 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.

Question 10

According to the 2019 ACC/AHA cardiovascular risk reduction guidelines, which dietary pattern is most strongly recommended to reduce ASCVD risk?

TheoryPractice · Accepted Answer

A diet emphasizing vegetables, fruits, whole grains, legumes, and lean protein with limited saturated fat, trans fat, and sodium. 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 Exam Questions & Answers 2026 (21–30)

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