NR 228 FINAL EXAM EXAM with Questions
and Answers/Plus a Rationale Updated 2026
A+/Instant Download PDF
Table of Contents
1. Nutrition and Metabolism Fundamentals
2. Nutritional Assessment and Screening
3. Therapeutic Diets and Chronic Disease Management
4. Lifespan Nutrition: Pediatrics to Geriatrics
5. Enteral and Parenteral Nutrition Support
6. Nutritional Pharmacology and Drug-Nutrient Interactions
1. A patient with a history of chronic obstructive pulmonary disease (COPD) presents with
unintentional weight loss and early satiety. Which nutritional intervention is most appropriate to
optimize caloric intake without exacerbating dyspnea?
A. Increase dietary fiber intake to improve bowel regularity and satiety.
B. Implement a regimen of small, frequent, nutrient-dense meals throughout the day.
C. Encourage the consumption of large, high-carbohydrate meals to maximize energy stores.
D. Recommend a liquid-only diet to reduce the metabolic demand of chewing and digestion.
CORRECT ANSWER : B
, Rationale: Small, frequent meals reduce gastric distension, which minimizes pressure on the
diaphragm and decreases dyspnea in COPD patients. High-fiber diets may cause bloating, and
large meals further compromise respiratory effort, while a liquid-only diet lacks the necessary
satiety and texture required for long-term nutritional adequacy.
2. A nurse is evaluating a patient with severe iron-deficiency anemia. The patient is prescribed oral
ferrous sulfate. Which education point is critical for optimizing absorption?
A. Administer the supplement with a glass of whole milk to protect the gastric mucosa.
B. Take the medication with a calcium-rich snack to neutralize potential gastric acidity.
C. Instruct the patient to consume the supplement with a source of Vitamin C to enhance
bioavailability.
D. Advise the patient to take the supplement immediately before bedtime to reduce systemic side
effects.
CORRECT ANSWER : C
Rationale: Vitamin C (ascorbic acid) creates an acidic environment in the duodenum, which
significantly increases the absorption of non-heme iron. Calcium and dairy products inhibit iron
absorption, and taking iron on an empty stomach is usually preferred to avoid food interactions,
though it may be taken with food if gastric distress occurs; however, Vitamin C is the clinical
priority for efficacy.
3. A patient is receiving long-term total parenteral nutrition (TPN). The nurse monitors for
metabolic complications. Which clinical finding requires immediate intervention?
A. Serum potassium level of 4.2 mEq/L.
B. A slight elevation in baseline blood glucose levels.
C. A sudden decrease in serum phosphorus, potassium, and magnesium levels.
D. Mild hypertriglyceridemia associated with the lipid emulsion infusion.
CORRECT ANSWER : C
Rationale: A sudden decrease in phosphorus, potassium, and magnesium during the initiation of
TPN is indicative of Refeeding Syndrome, which can be life-threatening if not managed
immediately. While minor glucose fluctuations or hypertriglyceridemia require monitoring, they
are expected outcomes that do not signify the acute, systemic metabolic collapse seen in
Refeeding Syndrome.
,4. A patient with Stage 4 Chronic Kidney Disease (CKD) who is not yet on dialysis is struggling
with hyperkalemia. Which food group should the nurse emphasize restricting?
A. Refined grains and white bread products.
B. Lean proteins such as chicken and egg whites.
C. High-potassium vegetables and fruits like potatoes, bananas, and tomatoes.
D. Healthy fats including olive oil and avocado.
CORRECT ANSWER : C
Rationale: In CKD, the kidneys lose the ability to excrete excess potassium, necessitating a
restriction of high-potassium foods like potatoes, bananas, and tomatoes to prevent cardiac
arrhythmias. Refined grains, lean proteins, and healthy fats do not inherently contain high levels
of potassium, though protein intake may also be managed based on the specific stage of CKD.
5. A patient is prescribed warfarin. The nurse should provide dietary education regarding the
consistency of which nutrient to ensure therapeutic stability?
A. Potassium-rich foods.
B. Vitamin K-rich foods such as spinach, kale, and broccoli.
C. Sodium-heavy processed meats and snacks.
D. High-cholesterol foods like red meat and butter.
CORRECT ANSWER : B
Rationale: Vitamin K is the antagonist to warfarin; therefore, inconsistent intake of green leafy
vegetables can cause wide fluctuations in the International Normalized Ratio (INR), rendering
the drug ineffective or toxic. Potassium, sodium, and cholesterol levels do not have the same
direct, antagonistic pharmacological interaction with warfarin as Vitamin K.
6. Which assessment tool is the gold standard for identifying patients at risk for malnutrition in an
acute care setting?
A. Body Mass Index (BMI) calculation alone.
B. The Braden Scale for Pressure Ulcer Risk.
C. The Malnutrition Screening Tool (MST) or Malnutrition Universal Screening Tool
(MUST).
, D. Subjective Global Assessment (SGA) performed by nursing assistants.
CORRECT ANSWER : C
Rationale: The MST and MUST are validated, reliable, and efficient screening tools designed
specifically to identify patients at risk for malnutrition in clinical settings. BMI is a measure of
body mass, not nutritional status, the Braden Scale measures skin integrity, and the SGA is a
comprehensive assessment tool typically reserved for clinicians, not a frontline screening tool.
7. A patient with a history of hypertension is advised to follow the DASH diet. Which mechanism
explains why this diet effectively lowers blood pressure?
A. It induces ketosis to promote rapid weight loss.
B. It eliminates all carbohydrates to stabilize insulin levels.
C. It increases intake of magnesium, potassium, and fiber while reducing sodium and
saturated fats.
D. It focuses exclusively on high-protein intake to promote satiety and muscle preservation.
CORRECT ANSWER : C
Rationale: The Dietary Approaches to Stop Hypertension (DASH) diet is designed to shift
electrolyte balances by increasing vasodilatory minerals (magnesium and potassium) and
reducing sodium. Eliminating carbohydrates or focusing solely on protein does not address the
underlying electrolyte and vascular mechanics targeted by the DASH protocol.
8. When caring for a patient with dysphagia, which dietary modification is most effective for
preventing aspiration during oral intake?
A. Providing thin liquids to ensure easy swallowing.
B. Encouraging the patient to tilt their head backward when swallowing.
C. Modifying food textures to a thickened consistency and utilizing the chin-tuck
maneuver.
D. Eliminating all solids and providing only room-temperature pureed foods.
CORRECT ANSWER : C
Rationale: Thickened liquids are more cohesive and move slower, providing better bolus control
for patients with dysphagia, while the chin-tuck maneuver closes the airway and opens the
esophagus. Tilting the head back increases the risk of aspiration, and pureed foods are not
necessary if the patient can safely manage other textures with appropriate thickening.
and Answers/Plus a Rationale Updated 2026
A+/Instant Download PDF
Table of Contents
1. Nutrition and Metabolism Fundamentals
2. Nutritional Assessment and Screening
3. Therapeutic Diets and Chronic Disease Management
4. Lifespan Nutrition: Pediatrics to Geriatrics
5. Enteral and Parenteral Nutrition Support
6. Nutritional Pharmacology and Drug-Nutrient Interactions
1. A patient with a history of chronic obstructive pulmonary disease (COPD) presents with
unintentional weight loss and early satiety. Which nutritional intervention is most appropriate to
optimize caloric intake without exacerbating dyspnea?
A. Increase dietary fiber intake to improve bowel regularity and satiety.
B. Implement a regimen of small, frequent, nutrient-dense meals throughout the day.
C. Encourage the consumption of large, high-carbohydrate meals to maximize energy stores.
D. Recommend a liquid-only diet to reduce the metabolic demand of chewing and digestion.
CORRECT ANSWER : B
, Rationale: Small, frequent meals reduce gastric distension, which minimizes pressure on the
diaphragm and decreases dyspnea in COPD patients. High-fiber diets may cause bloating, and
large meals further compromise respiratory effort, while a liquid-only diet lacks the necessary
satiety and texture required for long-term nutritional adequacy.
2. A nurse is evaluating a patient with severe iron-deficiency anemia. The patient is prescribed oral
ferrous sulfate. Which education point is critical for optimizing absorption?
A. Administer the supplement with a glass of whole milk to protect the gastric mucosa.
B. Take the medication with a calcium-rich snack to neutralize potential gastric acidity.
C. Instruct the patient to consume the supplement with a source of Vitamin C to enhance
bioavailability.
D. Advise the patient to take the supplement immediately before bedtime to reduce systemic side
effects.
CORRECT ANSWER : C
Rationale: Vitamin C (ascorbic acid) creates an acidic environment in the duodenum, which
significantly increases the absorption of non-heme iron. Calcium and dairy products inhibit iron
absorption, and taking iron on an empty stomach is usually preferred to avoid food interactions,
though it may be taken with food if gastric distress occurs; however, Vitamin C is the clinical
priority for efficacy.
3. A patient is receiving long-term total parenteral nutrition (TPN). The nurse monitors for
metabolic complications. Which clinical finding requires immediate intervention?
A. Serum potassium level of 4.2 mEq/L.
B. A slight elevation in baseline blood glucose levels.
C. A sudden decrease in serum phosphorus, potassium, and magnesium levels.
D. Mild hypertriglyceridemia associated with the lipid emulsion infusion.
CORRECT ANSWER : C
Rationale: A sudden decrease in phosphorus, potassium, and magnesium during the initiation of
TPN is indicative of Refeeding Syndrome, which can be life-threatening if not managed
immediately. While minor glucose fluctuations or hypertriglyceridemia require monitoring, they
are expected outcomes that do not signify the acute, systemic metabolic collapse seen in
Refeeding Syndrome.
,4. A patient with Stage 4 Chronic Kidney Disease (CKD) who is not yet on dialysis is struggling
with hyperkalemia. Which food group should the nurse emphasize restricting?
A. Refined grains and white bread products.
B. Lean proteins such as chicken and egg whites.
C. High-potassium vegetables and fruits like potatoes, bananas, and tomatoes.
D. Healthy fats including olive oil and avocado.
CORRECT ANSWER : C
Rationale: In CKD, the kidneys lose the ability to excrete excess potassium, necessitating a
restriction of high-potassium foods like potatoes, bananas, and tomatoes to prevent cardiac
arrhythmias. Refined grains, lean proteins, and healthy fats do not inherently contain high levels
of potassium, though protein intake may also be managed based on the specific stage of CKD.
5. A patient is prescribed warfarin. The nurse should provide dietary education regarding the
consistency of which nutrient to ensure therapeutic stability?
A. Potassium-rich foods.
B. Vitamin K-rich foods such as spinach, kale, and broccoli.
C. Sodium-heavy processed meats and snacks.
D. High-cholesterol foods like red meat and butter.
CORRECT ANSWER : B
Rationale: Vitamin K is the antagonist to warfarin; therefore, inconsistent intake of green leafy
vegetables can cause wide fluctuations in the International Normalized Ratio (INR), rendering
the drug ineffective or toxic. Potassium, sodium, and cholesterol levels do not have the same
direct, antagonistic pharmacological interaction with warfarin as Vitamin K.
6. Which assessment tool is the gold standard for identifying patients at risk for malnutrition in an
acute care setting?
A. Body Mass Index (BMI) calculation alone.
B. The Braden Scale for Pressure Ulcer Risk.
C. The Malnutrition Screening Tool (MST) or Malnutrition Universal Screening Tool
(MUST).
, D. Subjective Global Assessment (SGA) performed by nursing assistants.
CORRECT ANSWER : C
Rationale: The MST and MUST are validated, reliable, and efficient screening tools designed
specifically to identify patients at risk for malnutrition in clinical settings. BMI is a measure of
body mass, not nutritional status, the Braden Scale measures skin integrity, and the SGA is a
comprehensive assessment tool typically reserved for clinicians, not a frontline screening tool.
7. A patient with a history of hypertension is advised to follow the DASH diet. Which mechanism
explains why this diet effectively lowers blood pressure?
A. It induces ketosis to promote rapid weight loss.
B. It eliminates all carbohydrates to stabilize insulin levels.
C. It increases intake of magnesium, potassium, and fiber while reducing sodium and
saturated fats.
D. It focuses exclusively on high-protein intake to promote satiety and muscle preservation.
CORRECT ANSWER : C
Rationale: The Dietary Approaches to Stop Hypertension (DASH) diet is designed to shift
electrolyte balances by increasing vasodilatory minerals (magnesium and potassium) and
reducing sodium. Eliminating carbohydrates or focusing solely on protein does not address the
underlying electrolyte and vascular mechanics targeted by the DASH protocol.
8. When caring for a patient with dysphagia, which dietary modification is most effective for
preventing aspiration during oral intake?
A. Providing thin liquids to ensure easy swallowing.
B. Encouraging the patient to tilt their head backward when swallowing.
C. Modifying food textures to a thickened consistency and utilizing the chin-tuck
maneuver.
D. Eliminating all solids and providing only room-temperature pureed foods.
CORRECT ANSWER : C
Rationale: Thickened liquids are more cohesive and move slower, providing better bolus control
for patients with dysphagia, while the chin-tuck maneuver closes the airway and opens the
esophagus. Tilting the head back increases the risk of aspiration, and pureed foods are not
necessary if the patient can safely manage other textures with appropriate thickening.
