Nutrition – RN Practice Questions

The following practice questions are written at NCLEX-RN level and emphasize total parenteral nutrition, enteral feeding management, complex diet teaching, and prioritization. Options are numbered to match the way the list displays.

Question 1

A client is receiving total parenteral nutrition (TPN) through a tunneled central catheter. The nurse discovers that the bag has been empty for an unknown period and no replacement bag is available from the pharmacy. Which action should the nurse take first?

1. Flush the catheter with normal saline and clamp it until the new bag arrives.
2. Hang 10% dextrose in water at the same rate the TPN was infusing.
3. Increase the rate of the client's maintenance intravenous fluids to compensate.
4. Obtain a capillary blood glucose and continue to monitor without intervention.

Answer: 2. Hang 10% dextrose in water at the same rate the TPN was infusing.

Rationale: TPN delivers a large, continuous dextrose load, and the pancreas responds with sustained endogenous insulin secretion. Abrupt cessation leaves that circulating insulin unopposed and produces rebound hypoglycemia, which can progress to seizures and loss of consciousness. Hanging 10% dextrose in water at the same rate maintains the carbohydrate delivery until TPN resumes, and the provider is then notified. Option 1 stops all dextrose and causes the very problem to be avoided. Option 3 delivers isotonic fluid with little or no dextrose in most cases and does not protect glucose. Option 4 correctly identifies the risk but does nothing to prevent harm; monitoring alone is not an adequate intervention when a preventive action is available.

Question 2

A nurse is initiating enteral nutrition for a client with anorexia nervosa who has eaten almost nothing for three weeks. Which laboratory values should the nurse monitor closely for refeeding syndrome? Select all that apply.

1. Serum phosphorus
2. Serum potassium
3. Serum magnesium
4. Serum albumin
5. Serum bilirubin

Answer: 1, 2, and 3. Serum phosphorus, potassium, and magnesium.

Rationale: When carbohydrate is reintroduced to a starved client, insulin surges and drives phosphate, potassium, and magnesium from the extracellular space into the cells. The hallmark abnormality is hypophosphatemia, and the accompanying hypokalemia and hypomagnesemia produce cardiac dysrhythmias, respiratory muscle weakness, seizures, and death. Thiamine is also depleted and is replaced before feeding begins. Albumin has a half-life of about 18 to 21 days and does not shift acutely, so it is useless for detecting refeeding syndrome. Bilirubin reflects hepatobiliary function and is not part of refeeding monitoring.

Question 3

A client receiving a continuous nasogastric tube feeding suddenly begins coughing forcefully, and the nurse notes new crackles in the right lower lobe and an oxygen saturation that has fallen from 96% to 88%. Which action should the nurse take first?

1. Auscultate over the epigastrium while injecting 30 mL of air.
2. Lower the head of the bed to reduce reflux.
3. Stop the tube feeding.
4. Obtain an order for a chest radiograph.

Answer: 3. Stop the tube feeding.

Rationale: These findings indicate aspiration. The first action is to stop the source of ongoing harm by turning off the feeding, then turn the client to the side, suction, apply oxygen, and notify the provider. A chest radiograph will be needed, but it is not the first action. Lowering the head of the bed worsens reflux and aspiration; the head of the bed should stay elevated. Auscultating an injected air bolus is an obsolete and unreliable placement check that has been abandoned in practice, and it does nothing for an actively aspirating client.

Question 4

A client with end-stage kidney disease has just begun maintenance hemodialysis. Which statement by the client indicates correct understanding of the dietary plan?

1. "Now that I am on dialysis I need to eat less protein than I did before."
2. "Now that I am on dialysis I should eat more protein, such as eggs and chicken."
3. "I can use a salt substitute freely now that dialysis removes my extra salt."
4. "I should drink extra fluids on dialysis days to help flush out the toxins."

Answer: 2. "Now that I am on dialysis I should eat more protein, such as eggs and chicken."

Rationale: Before dialysis, protein is restricted to roughly 0.6 to 0.8 g/kg/day to limit nitrogenous waste accumulation. Once hemodialysis begins, amino acids are lost into the dialysate with each treatment, and protein needs rise to approximately 1.2 g/kg/day of high-biologic-value protein. Option 1 reverses this relationship. Option 3 is dangerous: salt substitutes are potassium chloride, and a dialysis client cannot excrete a potassium load, risking fatal hyperkalemia. Option 4 is wrong because fluid is restricted, commonly to about 1000 mL/day plus urine output, and excess fluid causes interdialytic weight gain, hypertension, and pulmonary edema.

Question 5

The nurse is caring for a client receiving TPN. Which nursing actions are appropriate? Select all that apply.

1. Change the administration set and filter every 24 hours.
2. Monitor capillary blood glucose every 4 to 6 hours.
3. Infuse the solution using an electronic infusion pump.
4. Increase the infusion rate to catch up if the infusion falls behind schedule.
5. Add ordered potassium chloride to the TPN bag at the bedside.
6. Assess the central catheter insertion site each shift for redness and drainage.

Answer: 1, 2, 3, and 6.

Rationale: TPN is a hypertonic, nutrient-rich solution that supports rapid bacterial growth, so the bag, tubing, and filter are changed every 24 hours with strict aseptic technique and the insertion site is assessed every shift for signs of catheter-related bloodstream infection. Hyperglycemia is the most common metabolic complication, so glucose is checked every 4 to 6 hours, at least initially. An infusion pump is required because rate variation destabilizes glucose. Option 4 is unsafe: "catching up" delivers a sudden dextrose bolus and causes hyperglycemia and osmotic diuresis; the rate is never increased to make up lost volume. Option 5 is unsafe: additives are compounded by pharmacy under a laminar flow hood, and adding drugs at the bedside risks contamination and precipitation.

Question 6

A nurse on a medical unit receives report on four clients. Which client should the nurse assess first?

1. A client receiving TPN whose temperature is 101.8°F (38.8°C) with new chills.
2. A client on a 2 g sodium diet who ate canned soup brought in by a family member.
3. A client receiving continuous tube feeding with a gastric residual volume of 180 mL and no abdominal distention.
4. A client whose prealbumin is 13 mg/dL and who has eaten 40% of meals.

Answer: 1. The client receiving TPN with a fever of 101.8°F and new chills.

Rationale: New fever with chills in a client with a central line receiving TPN indicates catheter-related bloodstream infection until proven otherwise, and sepsis can deteriorate within hours. This client requires immediate assessment, blood cultures from the catheter and a peripheral site, and provider notification. Option 2 requires teaching and sodium and weight monitoring but is not an emergency. Option 3 describes a residual well below common hold thresholds with no other signs of intolerance; current guidance does not support holding feeding for residuals under 500 mL absent symptoms. Option 4 is a chronic, expected finding in a poorly eating client and warrants a dietitian referral, not an urgent response.

Question 7

A client newly prescribed warfarin asks about diet. Which instruction should the nurse provide?

1. "Completely eliminate green leafy vegetables from your diet."
2. "Eat a large green salad every day to keep your blood thin."
3. "Keep your intake of green leafy vegetables about the same from week to week."
4. "Take a daily multivitamin containing vitamin K to keep your levels steady."

Answer: 3. "Keep your intake of green leafy vegetables about the same from week to week."

Rationale: Warfarin works by antagonizing vitamin K-dependent synthesis of clotting factors II, VII, IX, and X. The dose is titrated to the client's habitual vitamin K intake, so consistency is the goal. A sudden surge in vitamin K lowers the INR and increases clot risk, while abrupt elimination raises the INR and increases bleeding risk. Options 1 and 2 both create swings and remove nutritionally valuable foods. Option 4 adds a vitamin K source that will require dose readjustment and should not be started without provider direction.

Question 8

A client with chronic kidney disease is prescribed calcium acetate. When should the nurse instruct the client to take this medication?

1. One hour before meals on an empty stomach
2. With each meal and snack
3. Two hours after meals
4. At bedtime with a full glass of water

Answer: 2. With each meal and snack.

Rationale: Calcium acetate is a phosphate binder. It works by binding dietary phosphorus in the gastrointestinal lumen so that phosphate is excreted in stool rather than absorbed. That chemistry requires the drug and the food to be present in the gut at the same time. Taken before, between, or long after meals, as in options 1, 3, and 4, the binder has no phosphorus to bind and simply delivers a calcium load, leaving the client hyperphosphatemic and at risk for secondary hyperparathyroidism and vascular calcification.

Question 9

A nurse is preparing to administer medications through a client's percutaneous endoscopic gastrostomy (PEG) tube. Which actions are appropriate? Select all that apply.

1. Flush with 30 mL of water before and after the medication administration.
2. Crush the extended-release metoprolol succinate tablet and mix it with water.
3. Administer each medication separately, flushing between drugs.
4. Use liquid formulations when they are available and appropriate.
5. Mix all of the client's medications together in the enteral formula.

Answer: 1, 3, and 4.

Rationale: Flushing with about 30 mL of water before and after administration and between each drug prevents occlusion and drug interaction within the tube lumen, and liquid formulations reduce clogging when they are available and the dosage form is appropriate. Option 2 is unsafe: crushing an extended-release or enteric-coated product destroys the release mechanism and delivers the entire dose at once, risking bradycardia and hypotension with metoprolol succinate. Option 5 is unsafe because mixing medications into the formula causes physical incompatibility, clogging, and unpredictable absorption, and it makes the dose impossible to verify if the feeding is interrupted.

Question 10

A client who had a subtotal gastrectomy reports dizziness, palpitations, diaphoresis, and abdominal cramping about 20 minutes after eating. Which dietary instructions should the nurse reinforce? Select all that apply.

1. Eat six small meals per day rather than three large ones.
2. Drink 8 ounces of fluid with each meal to aid digestion.
3. Increase intake of protein and reduce simple sugars.
4. Lie down or recline for 20 to 30 minutes after eating.
5. Choose high-carbohydrate foods such as fruit juice and sweetened cereal.

Answer: 1, 3, and 4.

Rationale: These symptoms describe early dumping syndrome, in which a hyperosmolar bolus enters the jejunum rapidly and pulls fluid into the bowel lumen, causing intravascular volume shift and vasomotor symptoms. Management slows gastric emptying: small frequent meals, higher protein and moderate fat, low simple carbohydrate, and reclining after meals to slow transit by gravity. Option 2 is wrong because fluids taken with meals accelerate gastric emptying; fluids are taken between meals, roughly 30 to 60 minutes before or after. Option 5 is wrong because simple sugars are the primary osmotic trigger and would worsen symptoms and increase the risk of late dumping hypoglycemia.

Question 11

The nurse is evaluating the response of a malnourished client to one week of nutrition support. Which laboratory value is the most useful indicator of short-term response?

1. Serum albumin
2. Prealbumin
3. Total protein
4. Blood urea nitrogen

Answer: 2. Prealbumin.

Rationale: Prealbumin, also called transthyretin, has a half-life of only 2 to 3 days, so it responds within days to changes in protein and calorie delivery, making it the standard marker for short-term monitoring. Albumin has a half-life of roughly 18 to 21 days and will not have changed meaningfully in a week. Total protein is even less sensitive and is dominated by albumin and globulins. Blood urea nitrogen reflects protein load, renal function, and hydration together and cannot isolate nutritional response. The nurse should still interpret prealbumin alongside markers of inflammation, since acute illness lowers it independent of intake.

Question 12

While the nurse is changing the intravenous tubing on a client's central venous catheter, the client suddenly becomes dyspneic, complains of chest pain, and develops hypotension and tachycardia. Which action should the nurse take first?

1. Place the client in high Fowler position and administer oxygen.
2. Clamp the catheter and place the client in a left lateral Trendelenburg position.
3. Withdraw the catheter several centimeters and reassess.
4. Obtain a stat 12-lead electrocardiogram.

Answer: 2. Clamp the catheter and place the client in a left lateral Trendelenburg position.

Rationale: This presentation during a tubing change is classic for venous air embolism. Clamping the catheter immediately stops further air entry, and positioning the client left side down with the head lower traps air in the right ventricular apex, away from the pulmonary outflow tract, so it does not obstruct pulmonary blood flow. Oxygen at 100% follows, and the provider and rapid response team are called. Option 1 upright would allow air to advance. Option 3 is never done and risks further air entry and catheter damage. Option 4 delays a life-saving positioning intervention.

Question 13

A client with newly diagnosed celiac disease is selecting foods from a menu. Which selection indicates that teaching has been effective?

1. Cream of wheat cereal with a slice of rye toast
2. Grilled chicken breast with rice and steamed carrots
3. Barley soup with saltine crackers
4. Breaded fish fillet with a whole wheat roll

Answer: 2. Grilled chicken breast with rice and steamed carrots.

Rationale: Celiac disease requires lifelong strict elimination of gluten, which is found in wheat, rye, and barley. Plain chicken, rice, and vegetables contain no gluten. Option 1 contains wheat (cream of wheat) and rye. Option 3 contains barley and wheat-based crackers. Option 4 contains wheat in both the breading and the roll. The nurse should also teach about hidden gluten in sauces, soy sauce, malt, and processed foods, and about cross-contamination from shared toasters, fryers, and cutting boards.

Question 14

A nurse is caring for a client with hepatic cirrhosis and ascites. Which components should the nurse expect in the prescribed nutrition plan? Select all that apply.

1. Sodium restriction
2. Fluid restriction if hyponatremia is present
3. Complete elimination of all dietary protein
4. Small frequent meals with a late evening snack
5. Adequate calorie intake to prevent muscle catabolism

Answer: 1, 2, 4, and 5.

Rationale: Sodium restriction is the cornerstone of ascites management, and fluid is restricted when dilutional hyponatremia develops. Clients with cirrhosis have accelerated fasting metabolism, so small frequent meals with a late evening carbohydrate and protein snack reduce overnight catabolism, and adequate calories preserve lean mass. Option 3 reflects outdated practice. Blanket protein elimination is no longer recommended, because these clients are typically protein depleted and restriction accelerates sarcopenia and worsens outcomes. Protein is provided at adequate levels, and hepatic encephalopathy is managed with lactulose and rifaximin rather than by starving the client of protein.

Question 15

A client with a stage 3 pressure injury has a serum albumin of 2.6 g/dL and reports poor appetite. Which nursing action is the priority?

1. Encourage the client to drink more water with each meal.
2. Consult the registered dietitian for a nutrition assessment and high-protein supplementation.
3. Document the finding and reassess the albumin in three weeks.
4. Instruct the client to take a daily multivitamin.

Answer: 2. Consult the registered dietitian for a nutrition assessment and high-protein supplementation.

Rationale: Wound healing depends on protein for collagen synthesis, and this client's albumin and intake history indicate protein-energy malnutrition that will stall healing regardless of dressing technique. Protein needs in the presence of a stage 3 pressure injury rise to roughly 1.2 to 2.0 g/kg/day, along with adequate calories, vitamin C, and zinc. The registered dietitian is the appropriate interprofessional referral for calculating and prescribing that plan. Option 1 addresses hydration but not the protein deficit and may reduce intake by producing early satiety. Option 3 delays intervention for three weeks while tissue breakdown continues. Option 4 supplies micronutrients but not the protein and calories the client needs.

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