RD exam Practice Questions 2026: 8 Exam-Style Items Explained

Answer: C — Severe weight loss

Percent weight change = (usual - current) / usual x 100 = 14 / 160 x 100 = 8.75%. The standard time-based thresholds call a 7.5% loss in 3 months significant and anything greater than 7.5% in 3 months severe, so 8.75% is severe. The same 5% / 7.5% / 10% cut-offs at 1, 3 and 6 months drive the long-term care weight-loss triggers.

• A. An unintended loss of nearly 9% in 3 months is well past every accepted threshold; calling it insignificant would miss a malnutrition risk flag.
• B. Significant is the band at about 7.5% in 3 months; this patient has gone beyond it, which moves her into the severe category.
• D. Percent weight change is calculated from usual and current weight alone; BMI adds context but is not needed to grade the loss.

Answer: B — Hypokalemia and hypochloremia

Repeated vomiting removes gastric hydrochloric acid and potassium, producing hypochloremia, hypokalemia and a metabolic alkalosis. Low potassium is the finding that makes purging behaviors dangerous, because it can trigger cardiac arrhythmias, so it is monitored closely during refeeding.

• A. Vomiting loses chloride rather than retaining it, and hyperglycemia is not a characteristic finding of purging.
• C. Potassium falls with purging; a high potassium would point toward renal failure or cell breakdown, not vomiting.
• D. Sodium tends to fall or stay normal with volume loss and vomiting does not raise magnesium; low magnesium is the more likely abnormality.

Answer: A — A gastric residual volume of 0 mL means the patient is not at risk of aspirating the feeding.

Gastric residual volume is a poor predictor of aspiration: a patient with a residual of zero can still aspirate, for example from reflux of oropharyngeal secretions. The 2016 SCCM/ASPEN critical-care guideline advises against using GRV as part of routine care and against holding feeds for a GRV under 500 mL without other signs of intolerance.

• B. This is correct practice: elevating the head of the bed 30 to 45 degrees is a standard aspiration-prevention measure for intubated or high-risk patients.
• C. This is correct practice: ICU patients often receive far less than ordered because of interruptions, so delivered volume should be monitored.
• D. This is correct practice: agents such as metoclopramide or erythromycin are recommended for high-risk patients or those showing feeding intolerance.

Answer: B — Renal dysfunction

The kidneys are the main route of phosphorus excretion, so a markedly high serum phosphorus most often reflects reduced renal function, as in chronic kidney disease. That is why phosphorus control (diet plus binders) is part of nutrition care in advanced CKD and dialysis.

• A. Sepsis is more often linked to low phosphorus, from cellular shifts and increased use, than to a value twice the upper limit.
• C. The hallmark of refeeding syndrome is a fall in phosphorus as insulin drives it into cells, the opposite of this result.
• D. Malnutrition depletes phosphorus stores; it does not raise the serum level to this degree.

Answer: B — Test-retest reliability (reproducibility)

Giving the same instrument to the same people at two time points and comparing the results measures test-retest reliability, also called reproducibility or stability. If the tool is reliable and nothing has changed, scores should agree closely between the two administrations.

• A. Inter-rater reliability compares the judgments of two or more different scorers on the same data, not one group measured twice.
• C. Internal consistency (for example Cronbach's alpha) looks at whether items within a single administration measure the same construct; it needs no second sitting.
• D. Content validity asks whether the items cover the topic they claim to measure, usually judged by experts; it is about accuracy, not consistency over time.

Answer: A — Six Sigma

Six Sigma is a data-driven method built on the DMAIC cycle (Define, Measure, Analyze, Improve, Control) whose stated aim is to reduce process variation until defects are close to zero. The stem's clues are the defect measurement, the root-cause analysis and the near-perfect target.

• B. Kaizen means continuous small improvements, often suggested by front-line staff; it does not center on statistical measurement of defects toward a near-zero target.
• C. TQM is an organization-wide philosophy of customer focus and employee involvement; it is broader and less tied to a single measured defect rate.
• D. Lean focuses on removing waste and non-value-added steps to speed a process, rather than on reducing variation and defects.

Answer: D — $8.54

Selling price = item food cost / target food-cost percentage = $2.562 / 0.30 = $8.54. At that price the ingredients represent exactly 30% of revenue, which is what a food-cost percentage target means.

• A. This adds 30% on top of cost ($2.562 x 1.30), which is a markup, not a 30% food-cost percentage.
• B. This does not correspond to dividing cost by 0.30; at $4.40 the food cost would be about 58% of the price.
• C. This doubles the cost, which gives a 50% food cost rather than 30%.

Answer: B — Entrees are produced on site, chilled or frozen and held, then rethermalized just before service.

In a ready-prepared system the operation cooks its own food but decouples production from service: items are chilled or frozen, stored, and reheated (rethermalized) when needed. That lets the kitchen produce in large batches on a schedule that does not have to match meal times.

• A. This is a conventional system, where production and service happen at the same place on the same day.
• C. This is an assembly/serve system, which buys food already prepared and does little or no cooking on site.
• D. This is a commissary (central production) system, defined by one production kitchen supplying separate service sites.