Q1.

A public health dietitian in collaboration with community partners has developed an education program for grade 3
students on healthy snacks. The program was piloted with children in two different schools and is now ready for use in all
city schools. What is the best strategy for the dietitian to take?
1. Contact the School Board to have the information put onto the Board’s website
2. Send copies of the program to all grade 3 teachers and offer in-service classes
3. Write a newsletter outlining the program plan and send to all school principals
4. Present the program to the Parent School Council in each school

Q2. In a small community hospital, a new product has been purchased to thicken liquids for clients with dysphagia. A new
recipe has been developed. What should the administrative dietitian do next?
1. Add the recipe to the nourishment binder and flag it for staff
2. Have foodservice staff attend an in-service to learn about the product and recipe
3. Write a memo about the product and send to all foodservice staff with their pay stub
4. Ask the clinical dietitian to do a presentation on dysphagia to the foodservice staff

Q3. A 70-year-old inactive client with chronic constipation is referred for counselling following hip replacement surgery. The
dietitian concludes that she is following Canada’s Food Guide and her diet contains at least 35 g of fibre. What should the
dietitian do next?
1. Document the assessment in the client’s chart and refer her to the physiotherapist
2. Tell the client that she needs to exercise more frequently
3. Tell the client that she is eating well and does not need to change her diet
4. Discuss the client’s activity needs with her and the physiotherapist

ANSWERS AND EXPLANATION

Q1
Option 1. leaves communication up to the client, no active communication by the dietitian
Option 2. the dietitian communicates the program to the clients (teachers) who will use it; thoroughness is demonstrated by
offering an in-service
Option 3. leaves it to principals to communicate with clients, no active communication by dietitian
Option 4. although it reaches some parents, it does not communicate with teachers and children

Q2
Option 1. leaves communication up to client, no active communication by dietitian
Option 2. the dietitian communicates the new product information to those using it
Option 3. assigns a lesser priority to the initiative by putting it in with the pay stubs; does not communicate with the staff who
will use the new product
Option 4. the presentation is on dysphagia, not on the new product/recipe
As written, this option could be acceptable as a next step in the implementation process. This emphasizes the need to read the
'temporal' aspect of questions. Although not all small community hospitals employ both an administrative and clinical dietitian,
you are asked to accept this scenario in this question.

Q3
Option 1. no active communication with the client
Option 2. telling the client what to do is not effective implementation/communication
Option 3. eliminates any communication with the client about what the best plan is
Option 4. the dietitian communicates plan with the client and appropriate other

ADMINISTRATION: These questions test for knowledge of the managerial functions involved in directing an organization or an
organizational segment. These questions cover such areas as: developing objectives and formulating policies; making decisions
based on the context of the administrator's position and authority; forecasting and planning; organizing; developing personnel;
coordinating and informing; guiding and leading; testing and evaluating; and budgeting.
SAMPLE QUESTION:
Which one of the following is the most important reason to record a new policy in writing once it has been adopted?
A. to ensure the acceptance of the new policy by staff
B. to minimize confusion in the interpretation of the new policy
C. to stop the practice of giving special consideration to individual cases
D. to ensure that the policy is integrated into the organization’s mission
SOLUTION:
This question asks for the most important reason to record a new policy in writing.
Choice A is not correct. Staff must be brought into the process of policy development before the policy is adopted to decrease
possible staff resistance to the new policy.
Choice B is the correct answer to this question. The written record of the policy will serve as the definitive reference for issues
or situations that the policy covers.
Choice C is not correct. Organizational policies serve as a guide to provide consistency in decision-making for those cases that
are covered by the policy, but no policy will cover every possible circumstance or situation. There may be exceptional cases
with special circumstances that are not fully covered by the policy. These exceptional cases must be considered individually on
a case by case basis.
Choice D is not correct. Having a policy in writing will not ensure that the policy is integrated into the organization’s mission.
Integration of the policy into the organization’s mission should have occurred when the policy was being drafted.
The correct answer to this sample question is B.

SUBJECT AREA 2
ADVANCED NUTRITION AND DIETETICS: These questions test for an advanced knowledge of nutrition and dietetics, with
emphasis on the needs of medical patients and other client groups of special concern. Topics may include the assessment of
nutritional needs, nutritional care planning, and the provision of therapeutic diets.
SAMPLE QUESTION:
An excess of which one of the following can leach calcium from bones?
A. carbohydrates
B. protein
C. trans fat
D. saturated fat
SOLUTION:
Choice A is not correct. Excess carbohydrates may increase the chance of excessive caloric intake, which may lead to weight
gain, but they do not affect the amount of calcium in bones.
Choice B is the correct answer to this question. As a body digests protein, it releases acids into the bloodstream, which the body
neutralizes by drawing calcium from the bones. Too much protein over an extended period of time can permanently weaken
bones.
Choice C is not correct. Excess trans fats increase the risk of getting cardiovascular illnesses, but they do not leach calcium from
bones.
Choice D is not correct. Too much saturated fat can have an adverse impact on health, but it does not affect the amount of
calcium in bones.
The correct answer to this sample question is B.

BASIC NUTRITION AND DIETETICS: These questions test for knowledge of basic nutrition and dietetics, including such areas as
the nutritional value of foods, nutritional needs of client populations, balanced diets, foods and their relationship to health, and
food purchasing and preparation.
SAMPLE QUESTION:
Which one of the following groups of nutrients do products in the Dairy group primarily provide?
A. calcium, potassium, Vitamin D
B. dietary fiber, Vitamin A, Vitamin E
C. folate, dietary fiber, Vitamin C
D. protein, B vitamins, iron
SOLUTION:
Choice A is the correct answer to this question. According to the United States Department of Agriculture’s MyPlate, foods in
the Dairy group primarily provide calcium, potassium, and Vitamin D.
Choice B is not the correct answer to this question. Dietary fiber, Vitamin A, and Vitamin E are primarily provided by foods in
the Vegetables group.
Choice C is not the correct answer to this question. Folate, dietary fiber, and Vitamin C are primarily provided by foods in the
Fruits group.
Choice D is not the correct answer to this question. Protein, the B vitamins, and iron are primarily provided by foods in the
Protein Foods group.
The correct answer to this sample question is A.
FOOD PREPARATION AND SERVICE PROGRAMS: These questions test for knowledge of large-scale food preparation and
service, with an emphasis on maintaining standards of food quality, nutrition, safety, and sanitation. There will be 15 questions
in this subject area on the written test.

SAMPLE QUESTION:
Assume that all of the following foods will be stored in the same refrigerator. Which one of the following should be stored on
the topmost shelf?
A. ground beef
B. poultry
C. frosted cake
D. fresh fish
SOLUTION:
Choice A is not the correct answer to this question. Ground beef should be stored below ready-to-eat foods so that juices
cannot drip and contaminate the prepared foods below.
Choice B is not the correct answer to this question. Poultry should be stored below ready-to-eat foodsin order to avoid
contaminating the foods below.
Choice C is the correct answer to this question. In order to avoid being contaminated, ready-to-eat foods should be stored
above any uncooked or raw foods.
Choice D is not the correct answer to this question. Fresh fish should be stored below ready-to-eat foods so that it does not
contaminate them.
The correct answer to this sample question is C.

PATIENT/CLIENT DIETARY CARE: These questions test for knowledge of the relationship of nutrient intake to health and to
restorative and rehabilitative medical treatment. Topics may include the selection of foods in accordance with a person's
preferences, history, and medical condition; foods included/excluded in commonly used special diets; and providing counseling
and education about nutritional needs
SAMPLE QUESTION:
When treating a patient who has been diagnosed with a milk allergy, which one of the following should be done first?
A. Eliminate all dairy products from the patient’s diet, and add a calcium supplement.
B. Try small amounts of lactose-containing foods, and gradually increase them.
C. Have the patient consume dairy foods separately from other foods.
D. Prescribe only fat-free dairy products.
SOLUTION:
Choice A is the correct answer to this question. If a patient has an allergy to milk, the first treatment should be eliminating all
sources of milk protein from the patient’s diet. A calcium supplement should be added to compensate for the loss of calcium
that results from the elimination of dairy products.
Choice B is not the correct answer to this question. Lactose is a sugar found in milk. A patient with a milk allergy may not be
able to tolerate even small amounts of lactose-containing food products.
Choice C is not the correct answer to this question. A patient who is allergic to milk should not consume any dairy foods.
Choice D is not the correct answer to this question. No dairy products should be prescribed for a patient who is allergic to milk.
The correct answer to this sample question is A.

PLANNING AND DEVELOPING IN-SERVICE TRAINING PROGRAMS: These questions will test a candidate's understanding of
training principles and techniques. The questions may cover such topics as developing, organizing, delivering, and assessing
staff training; basic teaching concepts; and determining participants' progress. The questions may be based on both group and
individual training.
SAMPLE QUESTION:
Which one of the following is the most objective way to effectively measure how much trainees have learned over the course of
a training program?
A. the trainees should fill out a written evaluation of their knowledge before and after the training
B. the instructor should use his knowledge of previous classes to determine how much the trainees have learned
C. the trainees should take a written quiz before and after the training
D. the supervisors of the trainees should be asked if the trainees work performance has improved
SOLUTION:
Choice A is not correct. Having trainees fill out an evaluation about how much they feel they have learned over the course of
training will lead to a subjective evaluation of their knowledge.
Choice B is not correct. Each class may retain more or less than previous classes, due to the different people that are taking it,
so the instructor’s knowledge of previous classes may skew how he views the current class.
Choice C is the correct answer to this question. A written quiz is an objective way to measure what the trainees knew before
the training took place and what they know after they have taken it. No personal biases are introduced.
Choice D is not correct. Asking the trainees supervisors if work performance has improved is also subjective, since the
supervisors may not be rating all of the trainees on the same criteria and their previous knowledge and relationship of the
trainees may influence their responses.
The correct answer to this sample question is C.

PROVIDING SERVICES TO WOMEN, INFANTS AND CHILDREN: These questions test for knowledge of the special needs of the
WIC program service population. Topics may include maternal and pediatric nutrition; breastfeeding and its relationship to the
health, nutrition, and development of the infant; and common nutritional problems of the economically disadvantaged.
SAMPLE QUESTION:
For a woman who is expecting one child and whose weight is normal, which one of the following is the minimum recommended
amount of weight that she should gain during her pregnancy?
A. 15 pounds
B. 20 pounds
C. 25 pounds
D. 30 pounds
SOLUTION:
Choice A and Choice B are not correct. Fifteen or twenty pounds is too little weight gain. The baby may not be getting the daily
supply of nutrients needed in order to develop.
Choice C is the correct answer to this question. Twenty-five pounds is the minimum weight gain needed to provide adequate
nutrients to the baby during pregnancy and for the woman to be prepared to breastfeed after delivery.
Choice D is not correct. The question asks for the minimum amount of weight gain needed. Thirty pounds is within the
recommended range, but it exceeds the minimum recommended weight gain.
The correct answer to this sample question is C.

PUBLIC CONTACT PRINCIPLES AND PRACTICES: These questions test for the ability to interact with other people, to gather and
present information, and to provide assistance, advice, and effective customer service in a courteous and professional manner.
Questions will cover such topics as understanding and responding to people with diverse needs, perspectives, personalities, and
levels of familiarity with agency operations, as well as acting in a way that both serves the public and reflects well on your
agency.
SAMPLE QUESTION:
A person approaches you expressing anger about a recent action by your department. Which one of the following should be
your first response to this person?
A. Interrupt to say you cannot discuss the situation until he calms down.
B. Say you are sorry that he has been negatively affected by your department’s action.
C. Listen and express understanding that he has been upset by your department’s action.
D. Give him an explanation of the reasons for your department’s action.
SOLUTION:
Choice A is not correct. It would be inappropriate to interrupt. In addition, saying that you cannot discuss the situation until the
person calms down will likely aggravate him further.
Choice B is not correct. Apologizing for your department’s action implies that the action was improper.
Choice C is the correct answer to this sample question. By listening and expressing understanding that your department’s action
has upset him, you demonstrate that you have heard and understand his feelings and point of view.
Choice D is not correct. While an explanation of the reasons for the action may be appropriate at a later time, at this moment
the person is angry and would not be receptive to such an explanation.
The correct answer to this sample question is C.

SUPERVISION: These questions test for knowledge of the principles and practices employed in planning, organizing, and
controlling the activities of a work unit toward predetermined objectives. The concepts covered, usually in a situational
question format, include such topics as assigning and reviewing work; evaluating performance; maintaining work standards;
motivating and developing subordinates; implementing procedural change; increasing efficiency; and dealing with problems of
absenteeism, morale, and discipline. There will be 15 questions in this subject area on the written test.
SAMPLE QUESTION:
Assume that the unit you supervise is given a new work assignment and that you are unsure about the proper procedure to use
in performing this assignment. Which one of the following actions should you take FIRST in this situation?
A. Obtain input from your staff.
B. Consult other unit supervisors who have had similar assignments.
C. Use an appropriate procedure from a similar assignment that you are familiar with.
D. Discuss the matter with your supervisor.
SOLUTION:
This question asks for the action that you should take FIRST in this situation.
Choice A is not correct. Since this assignment is new for your unit, your staff would not be expected to be more knowledgeable
than you about the proper procedure.
Choice B is not correct. Although discussing this matter with other supervisors may increase your knowledge of the new
assignment, similar assignments performed in other units may differ in some important way from your new assignment. Other
units may also function differently from your unit, so the procedures used to perform similar assignments may differ
accordingly.
Choice C is not correct. Since this assignment is new for your unit, you would have no way of knowing whether the procedure
from a similar assignment is appropriate to use. You would need someone with the appropriate knowledge, usually your
supervisor, to determine if the procedure from a similar assignment could be used before you actually employed this procedure
in the performance of your new assignment.
Choice D is the correct answer to this question. Your supervisor is more likely to be informed about what procedure may be
appropriate for work that he or she assigns to you than would other unit supervisors or your staff. Even if your supervisor does
not know what procedure is appropriate, a decision regarding which procedure to use should be made with his or her
participation, since he or she has the ultimate responsibility for your unit’s work.
The correct answer to this sample question is D.

Gastric atrophy leads to

a. Iron deficiency anemia
b. Peptic ulcer
c. Pernicious anemia
d. Aplastic anemia

CASE 1
A dietitian has been consulted to review the puréed menu in a long-term care facility. The dietitian was also asked to provide
recommendations on the feasibility of using outsourced products to address their food safety concerns with the preparation of
puréed foods. The present non-selective puréed menu provides 30-35 g of protein and 6,800-9,200 kJ (1,600-2,200 kcal) per
day. In addition, residents are offered three between-meal nourishments.
The last audit indicated that 40% of the time, residents did not accept the nourishments offered.
QUESTIONS A to D refer to this case.
1. What is the primary concern with the puréed menu?
1. Inadequate energy
2. Inadequate protein
3. Inadequate number of nourishments
4. Inadequate number of meals
2. What action should the dietitian recommend initially regarding the unaccepted nourishments?
1. Switch to other nourishments
2. Discuss possible solutions with the facility manager
3. Identify the problem with the clients
 4. Eliminate the nourishments and increase meal portions
3. The dietitian recommends purchasing outsourced puréed entrées on a one-month trial.
The entrées will be evaluated on many factors during the trial. When the dietitian makes a final recommendation, which
should be the deciding factor?
1. Cost savings in labour hours
2. Refrigerator and freezer storage space
3. Acceptance of the entrées by residents
4. Cost of outsourced puréed entrées
4. Using outsourced products on a trial basis will require changes in kitchen routines. What action should the dietitian
recommend for initiating the trial?
1. Approach the manufacturer’s representative to coordinate the trial
2. Meet with staff to discuss the new products and handling procedures
3. Instruct a supervisor to test the new products and assign staff later
4. Contact Public Health and speak to nursing staff to build consensus

CASE 2
A 25-year-old client with cerebral palsy (CP) lives in a group home. His motor, mental and communication functions are partly
affected by his CP. He is presently experiencing end-stage renal disease (ESRD) and dialysis treatment in the future is
inevitable. The dietitian knows him well and is planning to meet with him to discuss his short-term and long-term nutrition
goals.
QUESTIONS 5 to 10 refer to this case.
5. How are diets for pre-end-stage renal disease (pre-ESRD) and dialysis different?
1. The recommended amount of dietary protein for pre-ESRD is lower than that for dialysis
2. The recommended amount of dietary protein for pre-ESRD is higher than that for dialysis
3. The recommended amount of dietary fat for pre-ESRD is lower than that for dialysis
4. The recommended amount of energy for pre-ESRD is higher than that for dialysis
5. To decide on the type of dialysis for the client, who should be consulted, in addition to the administrator of the home?
1. The client and the hospital renal team
2. A designated decision-maker for the client and the hospital renal team
3. The client and/or a designated decision-maker and the hospital kidney transplant team
4. The client and/or a designated decision-maker and the hospital renal team
7. If the client goes on hemodialysis, which conditions should the dietitian consider in the long term?
1. Hypokalemia and hyperphosphatemia
2. Hyperlipoproteinemia and osteodystrophy
3. Hyperkalemia and hypophosphatemia
4. Hypotension and diabetes
8. The client is known to consume large amounts of fresh fruit, vegetables and snacks such as potato chips. Which condition
will most likely result if he continues this diet?
1. Hyperkalemia
2. Hyperphosphatemia
3. Hyponatremia
4 Elevated urea
9. The administrator of the home calls the dietitian to report that the client has beeneating potato chips again. He has some
edema and his blood pressure is rising. What action should the dietitian take?
1. Discontinue services for the client
2. Explain to the administrator that the client has been advised about his diet already
3. Ask the administrator to monitor the situation
4. Meet with the client and/or a designated decision-maker to discuss the situation
10. One year later, the client is on hemodialysis and arrives for dialysis with a weight gain of 2 kg over the prescribed limit.
He has a normal serum sodium. What is the most likely cause of his weight gain?
1. Too much phosphorous and potassium
2. Too much fluid and potassium
3. Too many fruits and vegetables
4. Too much fluid and sodium
11. An 83-year-old woman was admitted to hospital for shortness of breath, nausea, vomiting and ascites. She reports a
recent rapid weight gain of 7 kg (height: 160 cm, present weight 67 kg). Upon admission, lab data reveal a low serum
albumin and normal liver function tests. Her diet provides about 6,000 KJ (1,400 kcal) and 60 g protein.
Which conclusion should the dietitian make based on this information?
1. Weight gain is a positive indicator of improved nutritional status
2. Recent weight gain reflects an increased oral intake
3. Serum albumin is low due to the intake of a low-protein, high-fat diet
4. Recent weight gain is related to low serum albumin
12. An 18-year-old client is referred to the dietitian for an initial visit about his lactose intolerance. The referral form
indicates that he is apprehensive and reluctant to discuss his symptoms. Which action would be most effective when
counselling him?
1. Engage him in dialogue to assess his verbal and non-verbal responses
2. Give him a list of foods to avoid
3. Provide him with a list of lactose-free products
4. Outline the changes he will have to make in his diet
13. A 75-year-old client with arthritis has low serum albumin, a reduced appetite and is edematous. What action by the
dietitian would be most effective in improving the client’s nutrition and health status?
1. Provide counselling on a high-energy, high-protein diet
2. Ask the client to complete a 3-day food record
3. Recommend that an appetite stimulant be ordered by the physician
 4. To eliminate the possibility of error, suggest the serum albumin test be repeated
14. The hospital dietitian was asked to prepare a heart health nutrition class for businessmen from the local community.
What is the most effective marketing activity for the dietitian to take?
1. Post an advertisement on the hospital bulletin board
2. Advertise in the local monthly business bulletin
3. Mail announcements to all city households
4. Advertise on the bulletin board at the local community centre
15. Which of the following manifestations are characteristic of bulimia nervosa?
1. Knuckle calluses, unwillingness to discuss food intake, amenorrhea
2. Erosion of dental enamel, knuckle calluses, psychological distress
3. Hypertension, low blood sugar, history of weight change
4. Ketoacidosis, hypotension, edema
16. The hospital dietitian learned that 43% of men over the age of 70 years in the community live at home and purchase
ready-to-serve meals. The dietitian would like to increase foodservice department revenue. Which strategy should the
dietitian use to maximize revenue?
1. Develop a menu of hospital-produced, ready-to-serve meals to be delivered to these men
2. Form a partnership with a local restaurant to provide ready-to-serve meals
3. Assess the feasibility of marketing hospital-produced, ready-to-serve meals to these men
4. Conduct a hospital-designed survey to verify that the community results can be replicated
17. The dietitian in a long-term care facility goes into the kitchen and sees a tray of egg salad sandwiches on the counter. An
hour later the sandwiches are still there. According to Hazard Analysis Critical Control Point (HACCP) guidelines, what should
the dietitian do first?
1. Ask the cook when the sandwiches were prepared
2. Take the temperature of the sandwiches
3. Discard the sandwiches and substitute
4. Refrigerate the sandwiches immediately until service
18. The dietitian is developing education materials to use in a pre-retirement worksite health promotion program. The
dietitian wants to be sure the audience understands the messages. The participants include several ethnic groups with a
range of literacy skills.
Which strategy would be most effective for the dietitian to use?
1. Hold a focus group with a representative sample of participants to pilot the material
2. Distribute a questionnaire at the end of the workshop to assess understanding
3. Use pictures, charts and diagrams to reinforce information presented in written form
4. Assess readability to confirm all materials are written at grade 6 level
19. A 13-year-old baseball player refuses to consume dairy products. Which recommendation would best meet her
nutritional needs?
1. Supplement daily with calcium and vitamin D
2. Insist that she consume one serving of yogurt daily
 3. Increase intake of other calcium-rich foods she likes
4. Consume 250 mL soy beverage daily
20. A group of people living independently in a senior citizen's complex asks the community dietitian for information about
shopping and cooking for one. What action should the dietitian take first?
1. Discuss with the group their concerns about the food they are currently buying and cooking
2. Organize a grocery store tour to point out the single serving foods available
3. Conduct a written survey with the seniors to determine food preferences and nutrition knowledge
4. Suggest that the group shop and cook their meals together
21. A 3-month-old breast fed infant is referred to the dietitian. His weight is at the 5th percentile and his length is at the 40th
percentile. No other medical problems are identified. His mother reports that he feeds frequently and requires four diaper
changes per day. What should the dietitian do first?
1. Advise his mother to feed him more frequently
2. Refer his mother to a support group that promotes breastfeeding
3. Obtain more information on his mother's milk supply and breastfeeding technique
4. Suggest his mother supplement breastfeeding with an infant formula
22. A client satisfaction survey conducted by the foodservice department in a children's hospital showed a low rating on the
fruit/dessert choice. Food return audits also showed a high level of fresh fruits returned. The dietitian is concerned that the
children are not meeting the recommendations in Canada's Food Guide during their hospital stay. Which action should the
dietitian take to promote healthy eating during hospitalization?
1. Provide nutrition education to clients on the daily menu to promote selection of healthy choices
2. Provide age appropriate fresh and canned fruits and vegetables and re-audit
3. Replace whole fruits with fruit juices and serve soup twice a day
4. Replace whole fruits on the menu with ice cream and increase vegetable portion sizes
23. A 70-year-old man with anemia of unknown cause is referred to the dietitian. The diet history shows an adequate intake
from all food groups in Canada's Food Guide. He mentions he has been taking herbal products for fatigue. Which action
should the dietitian take first?
1. Recommend a daily iron supplement taken with orange juice
2. Assess his intake of foods rich in iron, vitamin B12, and folate
3. Research the herbal products he is taking
4. Determine his living circumstances before giving advice
24. A 53-year-old man with bowel cancer is recovering from surgery, where much of the colon was removed. What is the
dietitian's main concern for this patient?
1. Increased loss of calcium
2. Decreased absorption of vitamin B12
3. Decreased absorption of fat soluble vitamins
4. Increased loss of fluids and electrolytes
25. An 80-year-old resident in a long-term care facility meets with the dietitian to discuss his frequent constipation.
Investigations have ruled out any underlying medical concern. The resident reports he has an excellent appetite and
consumes all meals and snacks offered at the facility. What would be the most likely contributing factor?
 1. Low fibre intake
2. Excessive consumption of cheese
3. Lack of physical activity
4. Inadequate fluid consumption
26. A 75-year-old woman on hemodialysis for chronic renal failure is referred to the dietitian for dietary assessment/review.
The client weighs 50 kg and is consuming 20 g protein per day. What should the dietitian recommend?
1. Refer the client to her family physician
2. Instruct the client on an increased protein intake
3. Refer the client to a more experienced dietitian
4. Instruct the client on a decreased protein intake
27. A consulting dietitian has been hired by a 200-bed long-term care facility to provide clinical nutrition services. While
charting in the foodservice department, the dietitian notes a 20 L mixer bowl of hot pudding being wheeled into the
refrigerator for chilling.
What should the dietitian do?
1. Suggest to the foodservice supervisor that they should use instant puddings that require no heating
2. Document the details of the incident and monitor staff food handling techniques
3. Continue with the clinical services for which the dietitian was contracted and recommend more staff training
4. Inform the foodservice supervisor to ensure the pudding is safely handled
28. The dietitian at a large health club wants to offer a 'Heart Smart' class on a pay-per- session basis. The manager is unsure
if the demand exists with the club members. What is the best way for the dietitian to assess present demand?
1. Interview all club members
2. Hold a focus group with club members
3. Offer an information session for club members
4. Survey all club members by questionnaire
29. The dietitian in a women's prison has been asked to implement a perpetual inventory system in the kitchen. What is the
main advantage of this system?
1. It provides a running balance of all food items
2. There is a separate card for all food items on hand
3. Food items can be easily counted once a month
4. Food items are listed in alphabetical order
30. A group of overweight women wants to learn more about food composition and food labelling in order to buy lower
energy foods. Which activity would be most useful for the dietitian to arrange for these clients?
1. A grocery store tour with discussion of their concerns
2. A presentation on the food labelling system used in Canada
3. A taste test of a variety of lower energy foods
4. A presentation on healthy eating and exercise
31. A 21-year-old man was referred to the dietitian to increase his weight. One of the goals set with the dietitian was for him
to consume two cans of high-energy liquid supplement per day. Three weeks later he remains at his previous weight and
states he did not take any of the supplements. Which action should the dietitian take now?
1. Review the previous goals and gently remind him to take the supplement
2. Reset goals in collaboration with the client
3. Suggest making milkshakes which are less expensive
4. Recommend more portable foods such as cookies and fruit
32. Following a case of suspected foodborne illness, the foodservice dietitian is designing a food safety training program for
employees. Which procedure is the most effective way for staff to prevent foodborne illness?
1. Preparation of potentially hazardous food in small batches
2. Rapid cooling of leftovers in shallow pans
3. Wearing hairnets and gloves at all times
4. Accurate labelling and dating of all foods in the refrigerator
33. For a nutrition month project, a dietitian managing a high school cafeteria introduced a daily low-fat special. Attractive
pricing and signage were unsuccessful in promoting sales. What action should the dietitian take?
1. Discontinue the low-fat menu option
2. Review the pricing of all regular items
3. Remove fried food choices from the menu
4. Explore other low-fat options with students
34. The dietitian has been asked to develop a lesson plan on breakfast for grade 3 students. The lesson will be delivered by
teachers and parents. What should the dietitian do first?
1. Develop learning objectives after discussion with parents and teachers
2. Develop learning activities appropriate for children in grade 3
3. Investigate computer games that appeal to children in grade 3
4. Investigate breakfast-eating practices of the teachers and parents
35. What is the ultimate goal of a dietetic regulatory body‘s Quality Assurance Program?
1. To assist dietitians in reviewing skills and identifying learning needs
2. To ensure public safety by confirming dietitians' competence
3. To systematically identify all dietitians' personal learning objectives
4. To be flexible enough to meet the learning needs of dietitians practicing in every segment of dietetics
Answers and Rationales for Sample Questions (Correct option RED)

Case 1
Q1 Competency: ASSESSMENT (formulates conclusions based on the interpretation and integration of data)
Option 1. Energy is within recommended intake for an elderly person.
Option 2. 30-35 g of protein is inadequate. Between 10-35% of daily calories from protein is recommended for an elderly
person.
Option 3. Three nourishments a day is acceptable, standard practice.
Option 4. Three meals a day is adequate especially when completed with nourishments.

Q2 Competency: ASSESSMENT (uses effective data collection techniques)

Option 1. Making changes without seeking the source of the problem may not solve the problem and could lead to bigger
problems.
Option 2. The facility manager is likely unaware residents aren't accepting the nourishments or the reasons for this. Same as
Option 1.
Option 3. The most accurate data will be collected directly from the clients. Then the problem can be analysed.
Option 4. Same as Option 1.

Q3 Competency: ASSESSMENT (identifies and confirms issues which have dietetic implications)
Option 1. Labour savings are important but there won't be savings or quality service if clients don’t eat the product and/or
request something else.
Option 2. Storage space won't matter if residents don't accept the product.
Option 3. Clients’ acceptance of the product is the most important factor in selecting menu items. If clients aren't satisfied, all
the other factors won’t matter. The product will not be eaten and nutritional status may be further impaired.
Option 4. Product cost is important but there won't be savings if the residents don’t eat the product and request something
else.

Q4 Competency: PLANNING (develops, with client & appropriate others, plans of action for managing the safe provision of
foods/nutrients)
Option 1. Staff members are more familiar with kitchen routines than a representative, less biased, and are more likely
identify other relevant issues.
Option 2. The most appropriate method of initiating any trial is to discuss the trial products/changes in routine with the users
(i.e. the staff preparing the product).
Option 3. The supervisor should be aware of the changes to tasks, but it is the staff who should work with the products during
a trial to assess fully.
Option 4. These groups are neither the consumer nor the user. You could seek feedback from nursing staff about client
acceptance during the trial.
Case 2
Q5 Competency: ASSESSMENT (integrates and interprets health record data)
Option 1. Pre-ESRD diet is lower in protein because kidneys are unable to filter protein molecules. Dialysis helps this process
allowing increased protein intake.
Option 2. See Option 1.
Option 3. Fat does not impact kidney function.
Option 4. Energy intake does not impact kidney function.

Q6 Competency: COMMUNICATION (collaborates with clients, colleagues, agencies, etc, during all phases of practice)
Option 1. The client might not be able to fully understand/decide for himself because of his affected mental and
communication functions.
Option 2. The client might still be able to be involved in decisions concerning his condition but he was excluded.
Option 3. The hospital kidney transplant team should not be involved at this time. The client's disease is not at this stage yet.
Option 4. The client might still be able to be involved in decisions, but may need a designated decision maker to be present.
The renal team needs to assess his condition.

Q7 Competency: IMPLEMENTATION (modifies the plan, as indicated through the monitoring process or as the result of
unexpected circumstances )
Option 1. Hyperphosphatemia should be monitored, but it's hyperkalemia (not hypokalemia) that should be considered in the
long term.
Option 2. Atherosclerosis is the most frequent cause of death among patients maintained on long-term hemodialysis.
Osteodystrophy can be caused by hyperphosphatemia which resorbs the calcium from the bones.
Option 3. Hyperkalemia should be monitored, but it's hyperphosphatemia (not hypophosphatemia) that should be monitored.
Option 4. Hypertension and diabetes should be monitored, not hypotension.

Q8 Competency: ASSESSMENT (integrates and interprets health record data)

Option 1. Fruits and vegetables including potatoes are high in potassium and could lead to hyperkalemia.
Option 2. Fruits and vegetables aren't high in phosphorous.
Option 3. Fruits and vegetables are low in sodium but would not cause hyponatremia.
Option 4. Elevated urea indicates ineffective dialysis; would not be caused by high fruit and vegetable consumption.

Q9 Competency ASSESSMENT (evaluates the process with respect to client satisfaction )

Option 1. Dietitian must continue services until otherwise ordered by the client’s physician.
Option 2. Dietitian should not disregard the administrator's concerns, especially if the client's blood pressure is rising and he
has edema.
Option 3. Dietitian should monitor the situation, not ask the administrator to do this.
Option 4. Dietitian should meet with client to discuss his eating habits, and evaluate the situation.

Q 10 Competency: ASSESSMENT (integrates and interprets health record data)

Option 1. Phosphorous and potassium won’t affect weight.
Option 2. Fluid intake would affect weight, but potassium wouldn’t.
Option 3. It is unlikely that fruit and vegetable consumption would affect weight.
Option 4. Weight gain in renal disease is usually linked to edema and can be caused by too much sodium (retains water). Total
fluid consumption is also crucial, because declined renal function prevents elimination of excess fluids.

INDEPENDENT QUESTIONS
Q 11 Competency: ASSESSMENT (Critical Thinking) integrates & interprets health record data
Option 1. Low serum albumin precludes an improved nutritional status.
Option 2. An energy intake of only 1,400 kcal could not be responsible for such a weight gain.
Option 3. Protein intake is within the recommended amount for the client. There is no mention of her dietary fat intake in the
data.
Option 4. Rapid and significant weight gain is most likely due to a shift in fluid balance. This is supported by the low albumin
level, which can result in edema, confirmed by her ascites.

Q12 Competency: COMMUNICATION (Application) seeks, recognizes and responds appropriately to feedback
Option 1. Drawing client out gently puts him at ease and establishes rapport. Non-verbal communication is a reliable
indicator of client apprehension.
Option 2. Dietitian shouldn't give client information before confirming his symptoms and condition. This disregards the referral
information provided.
Option 3. Same as Option 2.
Option 4. Same as Option 2.

Q13 Competency: IMPLEMENTATION (Application) executes the plan by managing the delivery of programs, products and
services
Option 1. A high-energy, high-protein diet will help elevate the client’s serum albumin which in turn will reduce edema. It will
improve nutritional status as well.
Option 2. A 3-day food record only confirms what is already known, that the client has a reduced appetite and is not eating
enough. Does not address nutritional status.
Option 3. Recommending medication or supplements should only be considered after efforts to improve oral intake fail.
Option 4. Low serum albumin is consistent with inadequate nutrition and edema and supported by other signs of deficiency.
Based on the information provided there is no basis for questioning the test results.
Note: The temporal aspect of this question places you at the outcome of “improved nutrition and health status for the client”. If
the question asked was, “What initial action should the dietitian take?”, the correct answer would be ‘complete a nutritional
assessment’.

Q14 Competency: COMMUNICATION Group (communicates effectively considering the client’s profile )
Options 1. The hospital personnel, visitors and patients aren’t the target audience.
Option 2. This will reach the largest number of the local businessmen (clients).
Option 3. City households aren't the target for this class.
Option 4. The community centre is not necessarily visited by local business personnel.

Q 15 Competency: ASSESSMENT (integrates and interprets health record data )

Option 1. Amenorrhea is mostly seen in anorexia clients, seldom in bulimic clients who are often of normal weight.
Option 2. Repeated scraping of knuckles on teeth when purging results in calluses.
Habitual vomiting erodes tooth enamel. Bulimic clients are often depressed/have mood swings.
Option 3. Hypertension and history of weight change are common in bulimic clients, but not low blood sugar.
Option 4. Hypotension and edema are common in bulimic clients, but ketoacidosis is not.

Q16 Competency: ASSESSMENT (integrates and interprets marketing data)

Option 1. A new menu should not be developed before assessing the situation.
It could actually cost the department money.
Option 2. Profit would be shared with the local restaurant, which would not maximize revenues for the department.
Option 3. The dietitian uses survey results to determine feasibility of project. To be cost effective, all costs must be considered.
Option 4. Conducting a second survey to replicate results would be costly and not achieve anything.

Q17 Competency: IMPLEMENTATION (monitors the achievement of the plan’s objectives according to safe provision of
foods/nutrients
Option 1. The cook’s information only becomes relevant after the temperature is taken.
Option 2. The temperature is the critical element that will determine whether the food is safe. Note the temporal aspect: this is
the first action needed.
Option 3. The sandwiches may not have to be discarded or substituted, once temperature is known.
Option 4. Refrigeration at this point provides a potential for serving unsafe food.

Q18 Competency: ASSESSMENT (identifies/obtains relevant data including factors affecting learning )
Option 1. Piloting the material in this way allows for revision as needed.
Option 2. This permits use of ineffective and inappropriate material.
Option 3. This may not suit participants’ learning abilities.
Option 4. Participants may be above or below grade 6 reading level. Does not consider the various ethnic groups.

Q19 Competency: PLANNING (develops a specific plan of action with the client and appropriate others to meet the
objectives for nutrition promotion and clinical nutrition by identifying the appropriate approach (dietary regimen)
Option 1. Before recommending supplements, alternate food sources should be considered.
Option 2. You cannot force her to change eating habits. The client has to be open to change.
Option 3. Other food sources of calcium should be explored with the client first.
Option 4. Not all soy beverages are fortified with calcium and 250 mL is not adequate to meet daily calcium needs.

Q20 Competency: PLANNING (develops a specific plan of action with the client and appropriate others to meet the objectives
for nutrition promotion and clinical nutrition by determining content. )
OPTION 1. The dietitian cannot develop a plan of action without first learning what the group is doing now.
OPTION 2. The dietitian needs to confirm what the actual concerns are first, before providing a solution such as this.
OPTION 3. Written surveys may limit the number of respondents due to barriers such as literacy or physical impairments to
reading.
OPTION 4. This is not a realistic solution as each person lives independently and it does not address their stated needs.

Q21 Competency: ASSESSMENT (identifies/obtains relevant data including health record data (e.g., anthropometric,
biochemical, clinical, dietary, psychosocial)
OPTION 1. It is the mother's perception that the infant feeds frequently. The dietitian needs to assess the situation first.
OPTION 2. Immediate action is required for the infant, whose growth is poor. Support is useful but does not address the issue.
OPTION 3. More information is needed to identify the cause of poor growth before forming a plan of action.
OPTION 4. This may be a possible solution, but initially, more information is needed to identify the cause of poor growth before
forming a plan of action.

Q22. Competency: ASSESSMENT (integrates and interprets quality management data (e.g., client satisfaction questionnaire,
standards of practice audit).
OPTION 1. Population turnover precludes this as an effective approach.
OPTION 2. The dietitian integrates data from quality assurance tools to improve the menu to help clients meet their nutritional
needs.
OPTION 3. This could negatively impact fibre intake and nutrient density.
OPTION 4. This action does not address the issue. Increasing portion size does not guarantee children will eat the foods.

Q23. Competency: ASSESSMENT (identifies/obtains relevant data including health record data (e.g., anthropometric,
biochemical, clinical, dietary, psychosocial)
OPTION 1. The type of anemia has not been confirmed.
OPTION 2. When there is insufficient information, the dietitian explores the problem and obtains additional information
through assessment before attempting to solve the problem.
OPTION 3. This is reasonable to do later, after the diagnosis is confirmed and the diet assessed.
OPTION 4. This is reasonable to do at a later time.

Q 24 Competency ASSESSMENT (formulates conclusions based on the interpretation and integration of data )
OPTION 1. This occurs more commonly with duodenum and jejunum resection.
OPTION 2. This occurs more commonly with ileum resection.
OPTION 3. This is most common with surgery of the duodenum and ileum.
OPTION 4. This is most common with colon resection.

Q25 Competency: ASSESSMENT (recognizes factors affecting an issue (e.g., psychosocial, cultural,political, legal, ethical,
religious )
OPTION 1. If the client consumes all meals/snacks offered at the facility, his fibre intake should be adequate.
OPTION 2. This deals with the myth that cheese causes constipation. It is also unlikely excessive cheese would be on a long-
term care facility menu due to cost.
OPTION 3. Many elderly people experience constipation due to decreased physical activity.
OPTION 4. If the client consumes all meals/snacks offered at the facility, fluid needs should be met.

Q26 Competency: ASSESSMENT (integrates and interprets dietary intake data (e.g., 24 hour recall, food frequency and food
record).)
OPTION 1. The dietitian is the appropriate health care professional to assess protein needs.
OPTION 2. The client requires more than 20 g of protein daily. Hemodialysis usually consists of 3-5 hours of treatment three
times per week. Dietary protein needs are 1.2 g/kg, about 50% high biologic value protein, to make up losses through the
dialysate.
OPTION 3. There is no indication the dietitian does not have the skills/knowledge to make this assessment.
OPTION 4. The client needs more, not less, protein than she is getting now.

Q27 Competency PROFESSIONAL PRACTICE (practices dietetics in accordance with the ethics of the profession by
identifying and acting appropriately in dealing with unethical or incompetent behaviour. )
OPTION 1. This does not solve the problem of improper cooling which may put residents at risk of food borne illness.
OPTION 2. Documentation is needed but alone, this is inadequate for the seriousness of the situation.
OPTION 3. This ignores the dietitian’s professional responsibility to correct a dangerous situation in the interest of the
residents' safety.
OPTION 4. It is the dietitian's responsibility to bring an occurrence that may cause harm to the residents to the immediate
attention of the foodservice supervisor to ensure that corrective action can be taken promptly.
Q 28 Competency ASSESSMENT (uses effective data collection techniques (e.g., interviews, surveys, literature reviews,
focus groups).
OPTION 1. This is not an effective method and is costly, time-consuming and unrealistic, since it is a large club, which would
have many members.
OPTION 2. Focus groups are useful to gain insight and obtain advice/opinions. They involve a small number of people and
would not necessarily provide information from the majority of club members needed to assess the demand adequately.
OPTION 3. This might give some indication of demand but would not answer the question about how many members would be
willing to pay. People may come to a free session but not to sessions where there is a charge.
OPTION 4. This is a systematic and efficient way to gather information and allows all members to respond.

Q 29 Competency: PLANNING (develops with client and appropriate other, plans of action for managing financial resources
(e.g., inventory management)
OPTION 1. This is the essence of a perpetual inventory.
OPTION 2. This can be done with a perpetual inventory but is not a major advantage.
OPTION 3. This is true for a physical inventory, not a perpetual inventory.
OPTION 4. Most inventory systems create an alphabetical listing, which by itself is not of particular value.

Q 30 Competency: EVALUATION (evaluates the process with respect to impact (e.g., financial, community, psychosocial
and nutritional benefit).
OPTION 1. A hands-on tour in the store addresses both labelling and purchasing and is likely to have the greatest impact on
the women's future purchases of lower energy foods.
OPTION 2. Passive learning, although it may increase the women's knowledge, is not as effective as application of that
knowledge.
OPTION 3. The women want information about food composition and buying lower energy foods, not just how they taste.
OPTION 4. This does not address the women's needs.

Q31 Competency: PLANNING (develops a specific plan of action with the client and appropriate others to meet the objectives
for nutrition promotion and clinical nutrition by identifying the appropriate approach (e.g., program, advocacy, feeding
route, dietary regimen).

OPTION 1. The dietitian would have to first determine why the client did not take the supplements to see if this is a viable
option to suggest.
OPTION 2. Goals should be determined in collaboration with the client.
OPTION 3. Expense has not been indicated as a barrier.
OPTION 4. Supplements are also portable, and portability has not been identified as a barrier.

Q32 Competency: (develops, with client and appropriate others, plans of action for managing human resources (e.g.,
recruiting, orienting, training, supervising, evaluating, scheduling).
OPTION 1. This is a good idea but if proper techniques are not used, batch size does not matter.
OPTION 2. Rapid cooling reduces the opportunity for bacterial growth, which reduces the risk of foodborne illness.
OPTION 3. Wearing hairnets does not decrease foodborne illness and gloves can be misused.
OPTION 4. Labelling, which includes dating, is important but if the product has been improperly cooled, proper labelling will
not prevent potential harm to clients.

Q33 Competency: PROFESSIONAL PRACTICE (applies a research approach to problem solving by examining a problem. )
OPTION 1. Further investigation of the problem is needed before acting.
OPTION 2. Pricing may not be the issue. See Option 1.
OPTION 3. This is a reasonable thing to do but fried foods may not be related to the lack of sales.
OPTION 4. The dietitian needs to find out more about the problem from the clients before deciding on a course of action.

Q34. Competency: PLANNING (establishes, with the client and appropriate others, realistic goals consistent with the
assessment, ethical considerations, legislation, and policies. )
OPTION 1. Learning objectives must be defined before planning a program.
OPTION 2. Learning activities would be planned to meet the learning objectives so would follow Option 1.
OPTION 3. See Option 2.
OPTION 4. This is not relevant as the lesson is for grade 3 students. This might be done as a way of engaging parents and
teachers who deliver the program, but would not be a first step.

Q35. Competency: PROFESSIONAL PRACTICE (commits to a high standard of professional competence through continuous
learning and self-development by identifying development needs in practicing dietetics. )
OPTION 1. This is only one step in the Quality Assurance (QA) process, which ultimately ensures the protection of the public.
OPTION 2: The mandate of all dietetic regulatory bodies is to protect the public interest. The QA program plays a critical role in
this process by confirming members’ competence on an ongoing basis.
OPTION 3: Identifying learning objectives is an initial step for the dietitian in the QA process. Objectives may be appropriate,
inappropriate, met or not met.
OPTION 4: Flexibility is a desirable quality in any QA program and individual learning needs can be met in a variety of settings.
However, flexibility does not address the incompetent practitioners, who are the target of a QA program.