Case Analysis & Practical Application Flashcards
7 cards from real CSR practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Case Analysis & Practical Application flashcards as text
A hemodialysis patient with a body mass index of 38 kg/m² and serum albumin of 4.1 g/dL reports excellent appetite but has persistent interdialytic weight gains of 5-6 kg. What is the MOST appropriate nutritional focus?
Answer: Implement sodium restriction to reduce thirst and fluid consumption between sessions
Excessive interdialytic weight gain is primarily driven by sodium intake, which stimulates thirst; restricting dietary sodium is the most direct dietary intervention.
A renal dietitian is counseling a patient newly diagnosed with IgA nephropathy and proteinuria of 2.5 g/day. Which protein recommendation is MOST appropriate at GFR 55 mL/min?
Answer: Moderate protein intake of approximately 0.8 g/kg/day to slow progression without causing malnutrition
Current guidelines recommend moderate protein restriction (0.8 g/kg/day) for CKD patients with proteinuria to slow progression while maintaining nutritional adequacy.
A PD patient's peritoneal equilibration test (PET) reveals high transport status. What nutritional implication should the renal dietitian consider?
Answer: High transporters absorb more glucose from dialysate, increasing risk for obesity, hypertriglyceridemia, and malnutrition due to faster protein losses
High transporters absorb more glucose from dialysate dextrose, increasing caloric load and cardiovascular risk, while also losing more protein into the dialysate.
A 65-year-old diabetic hemodialysis patient has a glycated hemoglobin (HbA1c) of 5.8% but frequently reports hypoglycemic episodes post-dialysis. What explains this discrepancy and what is the dietary recommendation?
Answer: HbA1c is falsely low in dialysis patients due to hemolysis/anemia; monitor glucose directly and ensure adequate carbohydrate intake around dialysis
HbA1c is unreliable in dialysis patients because shortened red blood cell survival leads to falsely low values; glycemic monitoring and dietary management should be based on direct glucose readings.
A renal transplant patient on cyclosporine develops gingival hyperplasia and asks about dietary modifications. What is the most nutritionally relevant counseling point?
Answer: Avoid grapefruit and grapefruit juice as they inhibit CYP3A4 and can increase cyclosporine toxicity
Grapefruit inhibits CYP3A4 metabolism, significantly increasing cyclosporine blood levels and risk of nephrotoxicity in transplant patients.
A hemodialysis patient's most recent labs show: phosphorus 7.2 mg/dL, calcium 8.1 mg/dL, PTH 620 pg/mL, and she reports taking her phosphate binders inconsistently. What is the MOST effective counseling strategy?
Answer: Educate her that binders must be taken WITH meals and snacks containing phosphorus to be effective, and explore barriers to adherence
Phosphate binders only bind phosphorus when taken with phosphorus-containing food; education about timing and barrier assessment are key to improving adherence.
An obese CKD Stage 3b patient (GFR 35 mL/min) asks about following a popular ketogenic diet for weight loss. What is the renal dietitian's MOST appropriate guidance?
Answer: A ketogenic diet may worsen acidosis and elevate potassium levels in CKD; a moderate calorie reduction with adequate but not excessive protein is safer
Ketogenic diets generate ketoacids and are high in protein and sometimes high in potassium-rich foods, making them potentially unsafe in CKD patients already prone to acidosis and hyperkalemia.