Gluten-Restricted Diet

Name ________________________________________________ Date ________________________

1. T / F Gluten-restricted diets restrict foods that have gluten or can be cross-contaminated with
other gluten-rich grains.

2. Which of the following foods are allowed on a gluten-restricted diet?

A. French toast and rye bread

B. Rice and corn

C. Croutons and breaded foods

D. Cream soups

3. T / F A patient on a gluten-restricted diet may have oatmeal.

4. If a patient is on a gluten-restricted diet, which of the following is available for the patient to
order?

A. Sliced pears or peaches

B. Gluten-restricted breakfast scramble

C. Diced citrus or plain tofu

D. Chocolate or vanilla pudding

E. All of the above

5. What products should a patient on a gluten-restricted diet AVOID:

A. Beer

B. Mixed melon cubes

C. Milk and yogurt

D. Peanut butter

Fluid Restriction Diet

Name ________________________________________________ Date ________________________

1. T / F A patient on a fluid restricted diet is allowed a limited amount of fluids on their meal trays.

2. How many cc’s in one fluid ounce?

3. T / F A beverage at lunch is okay for 1200 cc fluid restriction.

4. Match the patient’s fluid restriction to how much fluid is the patient allowed to have each meal?

1000-1200 cc 120 cc at Breakfast only

1500-2000 cc 240 cc at Breakfast at Breakfast, Lunch and Dinner

2500 cc 360 cc at Breakfast at Breakfast, Lunch and Dinner

5. T / F Any food that melts at room temperature must be monitored on Fluid Restricted diets.

6. T / F These are the conversions for a carton of milk: 8 oz = 1 cup = 240 cc

Consistent Carbohydrate Diet

Name ________________________________________________ Date ________________________

1. T / F Consistent Carbohydrate diets manage carbohydrate intake for patients that need help
controlling blood glucose levels.

2. What does GMC stand for?

3. If a patient is on a Consistent Carbohydrate (Ccarb) diet and the restriction level is not listed,
which of the following is the default carbohydrate restriction?

A. 45 GMC

B. 60 GMC

C. 75 GMC

D. 90 GMC

4. How many carbohydrate exchanges in a 75 GMC diet?

5. What is the approximate value (measured in grams) of one carbohydrate exchange (CHO
choice)?

A. 10 grams

B. 15 grams

C. 20 grams

D. 25 grams

6. If the patient is on a Consistent Carbohydrate diet (Ccarb), approximately how many

carbohydrate exchanges (or CHO choices) can the patient go over the specified limitation in the
diet per meal?

A. 0 CHO choice

B. 1 CHO choice

C. 2 CHO choice

D. 3 CHO choice

7. Circle all of the foods that are considered carbohydrate exchanges: bread, cereal, French toast,
pancake, rice, potatoes, pasta, vanilla wafers, crackers, sherbet and low-calorie custard and
pudding.

2 Gram Sodium Diet

Name ________________________________________________ Date ________________________

1. Name one type of patient diagnosis that may be on a sodium restriction.

2. T / F Bacon, pickles, and cottage cheese should all be avoided on a 2 gram sodium diet.

3. What is the maximum amount of sodium that a patient on a 2 gram sodium diet can have per
day?

A. 1000 milligrams

B. 1500 milligrams

C. 2200 milligrams

D. 2700 milligrams

4. What is the maximum amount of sodium that a patient can have per meal?

A. 650 milligrams

B. 750 milligrams

C. 800 milligrams

D. 900 milligrams

5. T / F A patient on a low-sodium diet can have sodium-reduced soup.

6. List one food that salt-restricted diets should avoid? (have high sodium).

3 gram Sodium Diet

Name ________________________________________________ Date ________________________

1. T / F Na is the symbol used for sodium.

2. What is the maximum amount of sodium in milligrams (mg) that a patient can have per day?

A. 1000 mg

B. 1500 mg

C. 2000 mg

D. 4000 mg

3. What is the maximum amount of sodium in milligrams (mg) that a patient can have per meal?

A. 1200 mg

B. 1300 mg

C. 800 mg

D. 900 mg

4. What salt alternative can you offer a patient?

5. What products should a patient on ANY sodium-restricted diet AVOID?

A. Caesar Salad Dressing (1 packet)

B. Vegetarian burger

C. Hawaiian Pizza

D. Providence Chef Salad

E. All of the above

Renal Diet (K 2)

Name ________________________________________________ Date ________________________

1. T / F Renal diets must restrict ALL of the following: protein, sodium, potassium and
phosphorus.

2. T / F Pro 70 Na 2 K 2 is the default restriction for a Renal diet?

3. Circle all foods that are considered LOW protein choices: meats, eggs, dairy, seeds, nuts,
legumes and beans.

4. If the patient is on a 2 gram potassium diet (K 2), what is the maximum amount of potassium that
the patient can have per day?

A. 2050 milligrams

B. 2200 milligrams

C. 2400 milligrams

D. 2750 milligrams

5. If the patient is on a 2 gram potassium diet (K2), what is the maximum amount of potassium that
the patient can have per meal?

A. 650 milligrams

B. 700 milligrams

C. 800 milligrams

D. 950 milligrams

Renal Diet (K 3)

Name ________________________________________________ Date ________________________

1. T / F K is the symbol used for the mineral potassium.

2. Circle all of the foods that are considered HIGH protein choices: fruits, vegetables, bread, pasta,
and potatoes.

3. If the patient is on a 3 gram potassium diet (K 3), what is the maximum amount of potassium that
the patient can have per day?

A. 2400 milligrams

B. 2700 milligrams

C. 3000 milligrams

D. 3200 milligrams

4. If the patient is on a 3 gram potassium diet (K 3), what is the maximum amount of potassium that
the patient can have per meal?

A. 600 milligrams

B. 800 milligrams

C. 1000 milligrams

D. 2000 milligrams

5. T / F All milk products are limited on a potassium-restricted diet or Renal diet.


Answer key

Gluten-restricted Diet Renal Diet (K 2)

1. True
1. False

2. B
2. True

3. False
3. All foods should be circled

4. E
4. B

5. A
5. B

Fluid Restriction Diet Renal Diet (K 3)

1. True
1. True

2. 30
2. All foods should be circled

3. False
3. C

1000-1200 cc = 120 cc @ Breakfast only

4. C

1500-2000 cc = 240 cc @ BLD

5. True
2500 cc = 360 BLD

4. True

5. True

Consistent Carbohydrate Diet

1. True

2. Grams per meal of carbohydrate

3. C

4. 5 carbohydrate exchanges

5. B

6. B

7. All foods should be circled

2 Gram Sodium Diet

1. Renal, Hypertension, Congestive Heart Failure

2. True

3. C

4. B

5. True

6. Lunchmeat, macaroni, pizza, soup, bacon, pickle,

cottage cheese, caesar salad dressing, WW tortilla
wrap, flatbread, chicken walnut salad with green
apple, shaved lean ham, vege burger, grill cheese,
cooked shrimp, Providence chef salad

3 gram Sodium Diet

1. True

2. D

3. A

4. Mrs. Dash

5. E