Nutrition falls under the Patient/Care Management domain, which makes up 32% of your test. You must know how to manage enteral feeding tubes, screen for malnutrition, and adapt diets for cultural preferences. Master these clinical skills using our bank of 4100+ practice questions.
Question 1
82 of 125. Hypertensive patient (BP 150/92 mmHg) with heart failure and new creatinine elevation (1.8 mg/dL, baseline 1.0) takes spironolactone. Which dietary modification reduces adverse risks?
- A) A) Restrict sodium to 2 g/day and monitor potassium intake✓
- B) B) Increase potassium-rich foods and fluid to 3 L/day
- C) C) Limit calcium-containing foods and high-fiber meals
- D) D) Avoid caffeine and implement DASH diet strictly
Show rationale
Spironolactone causes potassium retention; sodium restriction manages HF/hypertension (AHA guidelines). Option A covers both risks. Option B dangerously increases potassium/fluid with spironolactone and renal impairment. Option C is irrelevant (no hypercalcemia). Option D's strict DASH may exceed potassium limits. Rising creatinine indicates renal vulnerability, requiring potassium/sodium balance.
Question 2
24 of 125. A nurse screens an obese patient (BMI 32) with rheumatoid arthritis using the MST tool. The patient scores 4/5 due to recent weight loss and reduced appetite from methotrexate. Which action aligns with malnutrition risk protocols?
- A) A) Initiate high-calorie supplements immediately
- B) B) Refer for comprehensive nutrition assessment✓
- C) C) Document BMI as protective against malnutrition
- D) D) Discontinue methotrexate to improve appetite
Show rationale
MST score ≥2 triggers referral per AND standards to evaluate malnutrition risk despite obesity. Supplements (A) are premature without assessment. BMI (C) doesn't negate risk from weight loss/medications. Stopping methotrexate (D) is non-clinical; side effects require management, not drug cessation. Referral ensures appropriate intervention for this high-risk profile.
Question 3
22 of 125. A nurse observes that a patient's nasoenteric feeding tube is occluded. The patient is receiving a fiber-containing polymeric formula. Flushing with 30 mL of warm water using moderate pressure was unsuccessful. What should the nurse do next?
- A) A) Attempt to flush the tube using a pancreatic enzyme solution.✓
- B) B) Use a smaller syringe to generate greater pressure for flushing.
- C) C) Instill a carbonated beverage like cola and clamp for 30 minutes.
- D) D) Notify the provider for an order to replace the feeding tube.
Show rationale
ASPEN/SCCM guidelines recommend using an enzyme solution (e.g., pancrelipase mixed with sodium bicarbonate) to dissolve formula clogs, especially with fiber-containing formulas, after warm water fails. Option B risks tube rupture. Option C (cola) is not sterile and can damage tubes. Option D (replacement) is premature before attempting enzymatic declogging, a standard nursing intervention. The fiber-containing formula cue points to enzyme use.
Question 4
48 of 125. A Mexican American patient with heart failure requires low-sodium meals but expresses dissatisfaction with bland hospital food. Family brings pozole stew. Which nursing action demonstrates cultural humility?
- A) A) Discourage homemade food due to unknown sodium content
- B) B) Request dietary consult for culturally adapted low-sodium recipes✓
- C) C) Allow the stew but administer extra diuretics prophylactically
- D) D) Suggest replacing hominy with lower-sodium vegetables in the stew
Show rationale
B engages the healthcare team to adapt cultural foods safely, respecting autonomy. Option A dismisses cultural preferences without solution. Option C violates medication safety principles. Option D modifies traditional dishes without collaboration, risking disrespect. Pozole traditionally uses high-sodium broth and hominy; adapting recipes maintains cultural connection while meeting clinical needs.
Question 5
13 of 125. A tube-fed patient with Crohn's disease develops watery diarrhea after starting clindamycin. Stool C. difficile is negative. Which action aligns with evidence-based practice?
- A) A) Discontinue enteral feeds and initiate TPN
- B) B) Add banana flakes to formula and continue rate
- C) C) Switch to fiber-enriched formula immediately
- D) D) Administer probiotic and maintain current regimen✓
Show rationale
Antibiotic-associated diarrhea without C. diff responds to probiotics per ESPEN guidelines. Stopping feeds (A) risks malnutrition. Banana flakes (B) thicken stool but don't address microbial imbalance. Fiber (C) may worsen diarrhea in acute inflammation. Probiotics (D) restore gut flora while maintaining nutrition. Discriminating cues: Crohn's requires ongoing nutrition support, and negative C. diff rules out isolation protocols.
Question 6
4 of 125. COPD patient with 10% unintended weight loss and prolonged weaning from mechanical ventilation has weak cough. ABG shows pH 7.32, PaCO2 52 mmHg. Which consult combination is most urgent?
- A) A) Dietary for high-calorie diet and physical therapy for strength training
- B) B) Respiratory therapy for BiPAP optimization and dietary for protein supplements
- C) C) Speech therapy for secretion management and dietary for calorie-dense foods✓
- D) D) Pulmonary rehab for breathing exercises and pharmacy for appetite stimulants
Show rationale
Weak cough and respiratory acidosis (pH 7.32) indicate urgent need for secretion control to prevent aspiration and respiratory failure, while weight loss requires nutritional support. Option C pairs speech therapy for airway protection with dietary intervention. Option A misses secretion risks. Option B addresses ventilation but not swallowing safety. Option D's pulmonary rehab is important but less urgent than secretion management in acute weaning failure.
Question 7
44 of 125. A diabetic patient post-total laryngectomy has SpO2 dropping to 89% during oral care. Tracheostomy secretions show food particles. Which action aligns with aspiration precautions?
- A) A) Suction the tracheostomy tube before oral care and elevate HOB to 45°✓
- B) B) Administer prophylactic antibiotics and increase oxygen flow rate
- C) C) Perform deep oropharyngeal suctioning during oral hygiene
- D) D) Thicken all oral liquids and delay mouth care until after meals
Show rationale
Food particles in trach secretions confirm aspiration. Suctioning prevents secretion entry, and HOB elevation reduces reflux risk per ASPEN guidelines. Option B addresses hypoxia but ignores aspiration etiology. Option C may injure mucosa and doesn't prevent aspiration during care. Option D increases aspiration risk with thickened liquids in laryngectomy patients and neglects oral hygiene. Pre-procedure suctioning and positioning are evidence-based first steps.
Question 8
17 of 125. A 62-year-old with diabetes and dysphagia post-stroke begins continuous enteral feeding via nasogastric tube. After 4 hours, the nurse notes blood glucose of 210 mg/dL and gastric residual volume of 300 mL. Which intervention best addresses both findings?
- A) A) Administer sliding-scale insulin and reduce formula rate by 50%
- B) B) Hold feeding for 2 hours and flush tube with 30 mL water
- C) C) Switch to intermittent bolus feeds and check glucose hourly
- D) D) Continue current rate, recheck residual in 1 hour, and initiate insulin✓
Show rationale
Elevated residual requires monitoring per ASPEN guidelines (recheck in 1 hour before altering nutrition), while hyperglycemia needs insulin to avoid underfeeding. Reducing formula (A) risks inadequate nutrition without addressing hyperglycemia. Holding feeds (B) may cause hypoglycemia and doesn't manage glucose. Bolus feeds (C) increase aspiration risk in dysphagia and may worsen glycemic control. Continuing feeds with close monitoring (D) maintains nutrition support while treating hyperglycemia.
Question 9
68 of 125. An 82-year-old with Parkinson's disease and dementia aspirates pureed foods during a videofluoroscopy. The patient resists thickened liquids. Which intervention prioritizes safety and dignity?
- A) A) Consult speech therapy for compensatory swallowing strategies✓
- B) B) Initiate nasogastric tube feeding with behavioral redirection
- C) C) Trial chin-down posture with nectar-thick liquids during meals
- D) D) Implement oral care protocol and offer ice chips frequently
Show rationale
Videofluoroscopy-confirmed aspiration requires SLP expertise for individualized strategies (e.g., texture modification, posture adjustments) per AMSN standards. Option B ignores patient autonomy and increases aspiration risk with NG tubes. Option C disregards confirmed aspiration with purees and patient refusal of thickened liquids. Option D addresses oral hygiene but not nutritional intake or aspiration prevention. SLP consultation targets the root cause while respecting preferences.
Question 10
63 of 125. A Muslim patient with type 2 diabetes controlled by insulin is admitted with hypoglycemia during Ramadan after fasting 14 hours. The patient insists on continuing fasting despite medical risks. Which action should the nurse prioritize?
- A) A) Contact the hospital chaplain to discuss religious exemptions with the patient
- B) B) Provide glucose gel immediately per hypoglycemia protocol and reassess✓
- C) C) Consult endocrinology for sliding scale insulin adjustment during fasting
- D) D) Educate on pre-dawn meal modifications to reduce hypoglycemia risk
Show rationale
Hypoglycemia requires immediate intervention per ADA guidelines, overriding cultural considerations. Option B addresses the acute risk first while keeping reassessment open. Option A delays treatment for non-urgent discussion. Option C addresses long-term management but neglects immediate danger. Option D provides education but fails to stabilize the emergency. Religious practices must be respected, but physiological safety takes precedence during life-threatening events.
Question 11
16 of 125. An elderly patient with dementia has BMI 19. Nurse notes temporal wasting and 10% weight loss. Which action aligns with MUST tool recommendations?
- A) A) Initiate high-protein supplements immediately
- B) B) Document as low risk with routine monitoring
- C) C) Refer for comprehensive nutritional support✓
- D) D) Calculate energy requirements using activity factor
Show rationale
MUST tool scores BMI<20 + weight loss as high risk (discriminating cues: dementia + objective wasting). Option A bypasses interdisciplinary assessment. Option B underestimates risk. Option D delays intervention. NICE guidelines mandate referral for high MUST scores to address multifactorial malnutrition. Muscle loss in elderly requires prompt intervention beyond supplements alone.
Question 12
57 of 125. A patient with DKA receives insulin infusion. Six hours later, potassium drops to 2.9 mEq/L despite 20 mEq KCl in maintenance fluids. ECG shows U waves. What is the safest potassium repletion strategy?
- A) A) Increase IV KCl to 40 mEq in 100 mL NS over 1 hour✓
- B) B) Administer 20 mEq KCl PO immediately
- C) C) Add 20 mEq KCl to current IV bag and repeat labs
- D) D) Switch to potassium phosphate IV at 10 mmol/hour
Show rationale
Severe hypokalemia with U waves in DKA requires aggressive IV repletion. Option A delivers 40 mEq/hour safely via central/peripheral line per ADA guidelines, balancing urgency with cardiac risk. Oral KCl (B) is too slow for symptomatic hypokalemia. Adding to maintenance fluids (C) provides <10 mEq/hour, delaying correction. Phosphate (D) risks hypocalcemia and doesn't replace potassium. Cues (DKA, ECG changes, inadequate prior repletion) justify controlled high-dose IV KCl.
Question 13
65 of 125. Four days post-abdominal trauma surgery, a patient has bowel sounds but develops ileus with bilious NG output >800 mL/day. Which nutrition approach aligns with SCCM guidelines?
- A) A) Start trophic enteral feeds while advancing slowly✓
- B) B) Initiate total parenteral nutrition today
- C) C) Withhold nutrition until ileus fully resolves
- D) D) Begin oral clear liquids as tolerated
Show rationale
SCCM recommends early trophic feeds for ileus if bowel sounds are present (discriminating cues: recent surgery and bilious output). Option A stimulates gut function without overloading. Option B is reserved for prolonged non-function; PN increases infection risk. Option C delays nutrition during hypermetabolism. Option D is insufficient and risky with high NG output. Trophic feeds are safe in partial obstruction and promote mucosal integrity.
Question 14
80 of 125. An obese diabetic (HbA1c 9.8%) requires emergency hemicolectomy. Prealbumin is 18 mg/dL. On postoperative day 5, bowel sounds are absent with abdominal distension. What nutrition approach minimizes risks?
- A) A) Start TPN with insulin protocol immediately
- B) B) Initiate PPN while advancing diet slowly
- C) C) Maintain NPO status with electrolyte replacement✓
- D) D) Begin trophic enteral feeds with glucose monitoring
Show rationale
Early postoperative ileus (<7 days) in a well-nourished patient (normal prealbumin) doesn't require nutrition support yet. ASPEN guidelines recommend withholding nutrition during acute ileus to avoid complications. TPN/PPN (Options A/B) increase infection and hyperglycemia risks in uncontrolled diabetes. Option D is contraindicated with absent bowel sounds. Electrolyte monitoring supports gut recovery before initiating nutrition.
Question 15
107 of 125. Post-radiation laryngeal cancer patient with 8% weight loss in 4 weeks coughs violently when drinking thin liquids but handles pudding safely. Which action addresses both nutrition and aspiration risk?
- A) A) Order calorie count and initiate 1.5 kcal/mL oral supplements
- B) B) Recommend speech therapy for modified barium swallow study✓
- C) C) Schedule dietary consult for high-calorie pureed diet only
- D) D) Start daily multivitamin and encourage frequent small meals
Show rationale
Violent coughing with thin liquids indicates aspiration risk requiring instrumental swallowing assessment (MBSS) by speech therapy. Option B targets dysphagia characterization for safe nutrition planning. Option A/C risk aspiration without defining safe consistencies. Option D ignores aspiration cues and insufficiently addresses acute weight loss. ASHA guidelines prioritize instrumental exams for new post-radiation swallowing changes.