NR 228 Final Exam Actual Exam 2026/2027 – Comprehensive
Nutrition & Dietary Guidelines with Detailed Rationales |
100% Verified | Pass Guaranteed – A+ Graded
Section A: Nutrition Fundamentals & Macronutrients
Q1: A 42-year-old patient with Type 2 diabetes mellitus is learning carbohydrate
counting. The registered dietitian explains that low-glycemic index foods are preferred
because they produce a slower rise in blood glucose. Which food choice BEST
represents a low-glycemic index option?
A. White bread with a glycemic index of 75
B. Baked potato with a glycemic index of 85
C. Lentils with a glycemic index of 32 [CORRECT]
D. Cornflakes with a glycemic index of 81
Correct Answer: C
Rationale: Lentils are a complex carbohydrate rich in soluble fiber, resulting in a low
glycemic index (≤55) and gradual glucose absorption. White bread, baked potatoes, and
cornflakes are high-glycemic index foods that cause rapid postprandial glucose spikes,
making them less desirable for glycemic control.
Q2: A 28-year-old vegan patient asks the nurse how to ensure adequate protein quality
in the diet. Which dietary strategy BEST ensures all essential amino acids are
consumed?
A. Consuming only soy products at every meal
B. Combining complementary proteins such as rice and beans within the same day
[CORRECT]
C. Eliminating all sources of dietary fat to maximize protein absorption
D. Consuming protein supplements exclusively instead of whole food sources
Correct Answer: B
,Rationale: Complementary protein combining pairs plant foods with different limiting
amino acids (e.g., grains low in lysine with legumes low in methionine) to provide all
nine essential amino acids over the course of a day. Soy is a complete protein but
variety is still important; fat restriction and exclusive supplement use are not
recommended strategies.
Q3: A patient with hyperlipidemia receives dietary counseling to reduce cardiovascular
risk. Which dietary modification is MOST effective for lowering low-density lipoprotein
(LDL) cholesterol?
A. Increasing dietary cholesterol intake to 500 mg/day
B. Replacing saturated fats with trans fats
C. Consuming 25-30 g/day of dietary fiber including soluble fiber from oats and
legumes [CORRECT]
D. Eliminating all dietary fat including unsaturated sources
Correct Answer: C
Rationale: Soluble fiber binds bile acids in the intestine, increasing cholesterol excretion
and reducing LDL synthesis. The American Heart Association recommends 25-30 g
total fiber daily. Trans fats and high dietary cholesterol raise LDL, and eliminating all fat
is unnecessary and potentially harmful as unsaturated fats are cardioprotective.
Q4: A 65-year-old patient reports chronic constipation and asks about increasing fiber
intake. The nurse recommends adding foods high in insoluble fiber. Which food is the
BEST source of insoluble fiber?
A. Oatmeal
B. Apples with skin
C. Wheat bran and whole grains [CORRECT]
D. Navy beans
Correct Answer: C
Rationale: Wheat bran and whole grains are rich in insoluble fiber, which adds bulk to
stool and speeds transit time through the colon, alleviating constipation. Oatmeal,
,apples, and beans contain more soluble fiber, which is beneficial for cholesterol and
glucose management but less effective for increasing stool bulk.
Q5: A nurse is calculating the total energy expenditure (TEE) for a 30-year-old sedentary
office worker. Which component accounts for the LARGEST percentage of daily caloric
expenditure in a healthy adult?
A. Thermic effect of food (TEF)
B. Physical activity energy expenditure
C. Basal metabolic rate (BMR) [CORRECT]
D. Adaptive thermogenesis
Correct Answer: C
Rationale: BMR represents 60-75% of TEE in most adults and reflects the energy
required for basic physiological functions at rest. Physical activity accounts for 15-30%,
TEF accounts for approximately 10% of energy intake, and adaptive thermogenesis is a
minor component. BMR is influenced by body composition, age, sex, and hormonal
status.
Q6: A 3-year-old child in a developing country presents with edema, flaky paint
dermatosis, hepatomegaly, and apathy. The child has adequate caloric intake from
starchy staples but limited protein sources. Which condition does this presentation
MOST likely represent?
A. Marasmus with severe wasting and fat depletion
B. Kwashiorkor with protein deficiency despite adequate calories [CORRECT]
C. Beriberi with neurological and cardiovascular impairment
D. Pellagra with dermatitis, diarrhea, and dementia
Correct Answer: B
Rationale: Kwashiorkor results from inadequate protein intake relative to caloric intake,
causing hypoalbuminemia, edema, fatty liver, and skin changes. Marasmus involves
severe total energy and protein deficiency with wasting and no edema. Beriberi
(thiamin) and pellagra (niacin) present with different classic triads.
, Q7: A patient on long-term total parenteral nutrition (TPN) without lipid emulsion
develops dry scaly skin, poor wound healing, and hair loss. Which essential fatty acid
deficiency is MOST likely?
A. Alpha-linolenic acid (omega-3) deficiency only
B. Linoleic acid (omega-6) deficiency [CORRECT]
C. Arachidonic acid deficiency secondary to omega-3 excess
D. Eicosapentaenoic acid (EPA) toxicity
Correct Answer: B
Rationale: Linoleic acid (omega-6) is an essential fatty acid required for skin integrity,
wound healing, and cell membrane structure. TPN without lipid emulsions rapidly
depletes linoleic acid stores, causing essential fatty acid deficiency within 1-2 weeks.
Omega-3 deficiency is less common and presents differently; arachidonic acid can be
synthesized from linoleic acid.
Q8: A postoperative patient receiving only 5% dextrose in water IV has a serum
prealbumin of 12 mg/dL (normal 18-40 mg/dL) and 24-hour urine nitrogen of 18 g with
minimal nitrogen intake. Which nitrogen balance status is present?
A. Positive nitrogen balance indicating anabolism
B. Nitrogen equilibrium with balanced intake and output
C. Negative nitrogen balance indicating catabolism and tissue breakdown [CORRECT]
D. Nitrogen balance cannot be determined from these data
Correct Answer: C
Rationale: Negative nitrogen balance occurs when nitrogen excretion exceeds intake,
indicating catabolism, tissue breakdown, and inadequate protein intake. This is
common post-surgery due to metabolic stress. Positive balance occurs during growth
or recovery; equilibrium indicates adequate protein intake matching losses.
Q9: A patient with metabolic syndrome asks about dietary fat recommendations. Which
type of fatty acid should be MINIMIZED to reduce cardiovascular disease risk?
A. Monounsaturated fatty acids from olive oil and avocados
Nutrition & Dietary Guidelines with Detailed Rationales |
100% Verified | Pass Guaranteed – A+ Graded
Section A: Nutrition Fundamentals & Macronutrients
Q1: A 42-year-old patient with Type 2 diabetes mellitus is learning carbohydrate
counting. The registered dietitian explains that low-glycemic index foods are preferred
because they produce a slower rise in blood glucose. Which food choice BEST
represents a low-glycemic index option?
A. White bread with a glycemic index of 75
B. Baked potato with a glycemic index of 85
C. Lentils with a glycemic index of 32 [CORRECT]
D. Cornflakes with a glycemic index of 81
Correct Answer: C
Rationale: Lentils are a complex carbohydrate rich in soluble fiber, resulting in a low
glycemic index (≤55) and gradual glucose absorption. White bread, baked potatoes, and
cornflakes are high-glycemic index foods that cause rapid postprandial glucose spikes,
making them less desirable for glycemic control.
Q2: A 28-year-old vegan patient asks the nurse how to ensure adequate protein quality
in the diet. Which dietary strategy BEST ensures all essential amino acids are
consumed?
A. Consuming only soy products at every meal
B. Combining complementary proteins such as rice and beans within the same day
[CORRECT]
C. Eliminating all sources of dietary fat to maximize protein absorption
D. Consuming protein supplements exclusively instead of whole food sources
Correct Answer: B
,Rationale: Complementary protein combining pairs plant foods with different limiting
amino acids (e.g., grains low in lysine with legumes low in methionine) to provide all
nine essential amino acids over the course of a day. Soy is a complete protein but
variety is still important; fat restriction and exclusive supplement use are not
recommended strategies.
Q3: A patient with hyperlipidemia receives dietary counseling to reduce cardiovascular
risk. Which dietary modification is MOST effective for lowering low-density lipoprotein
(LDL) cholesterol?
A. Increasing dietary cholesterol intake to 500 mg/day
B. Replacing saturated fats with trans fats
C. Consuming 25-30 g/day of dietary fiber including soluble fiber from oats and
legumes [CORRECT]
D. Eliminating all dietary fat including unsaturated sources
Correct Answer: C
Rationale: Soluble fiber binds bile acids in the intestine, increasing cholesterol excretion
and reducing LDL synthesis. The American Heart Association recommends 25-30 g
total fiber daily. Trans fats and high dietary cholesterol raise LDL, and eliminating all fat
is unnecessary and potentially harmful as unsaturated fats are cardioprotective.
Q4: A 65-year-old patient reports chronic constipation and asks about increasing fiber
intake. The nurse recommends adding foods high in insoluble fiber. Which food is the
BEST source of insoluble fiber?
A. Oatmeal
B. Apples with skin
C. Wheat bran and whole grains [CORRECT]
D. Navy beans
Correct Answer: C
Rationale: Wheat bran and whole grains are rich in insoluble fiber, which adds bulk to
stool and speeds transit time through the colon, alleviating constipation. Oatmeal,
,apples, and beans contain more soluble fiber, which is beneficial for cholesterol and
glucose management but less effective for increasing stool bulk.
Q5: A nurse is calculating the total energy expenditure (TEE) for a 30-year-old sedentary
office worker. Which component accounts for the LARGEST percentage of daily caloric
expenditure in a healthy adult?
A. Thermic effect of food (TEF)
B. Physical activity energy expenditure
C. Basal metabolic rate (BMR) [CORRECT]
D. Adaptive thermogenesis
Correct Answer: C
Rationale: BMR represents 60-75% of TEE in most adults and reflects the energy
required for basic physiological functions at rest. Physical activity accounts for 15-30%,
TEF accounts for approximately 10% of energy intake, and adaptive thermogenesis is a
minor component. BMR is influenced by body composition, age, sex, and hormonal
status.
Q6: A 3-year-old child in a developing country presents with edema, flaky paint
dermatosis, hepatomegaly, and apathy. The child has adequate caloric intake from
starchy staples but limited protein sources. Which condition does this presentation
MOST likely represent?
A. Marasmus with severe wasting and fat depletion
B. Kwashiorkor with protein deficiency despite adequate calories [CORRECT]
C. Beriberi with neurological and cardiovascular impairment
D. Pellagra with dermatitis, diarrhea, and dementia
Correct Answer: B
Rationale: Kwashiorkor results from inadequate protein intake relative to caloric intake,
causing hypoalbuminemia, edema, fatty liver, and skin changes. Marasmus involves
severe total energy and protein deficiency with wasting and no edema. Beriberi
(thiamin) and pellagra (niacin) present with different classic triads.
, Q7: A patient on long-term total parenteral nutrition (TPN) without lipid emulsion
develops dry scaly skin, poor wound healing, and hair loss. Which essential fatty acid
deficiency is MOST likely?
A. Alpha-linolenic acid (omega-3) deficiency only
B. Linoleic acid (omega-6) deficiency [CORRECT]
C. Arachidonic acid deficiency secondary to omega-3 excess
D. Eicosapentaenoic acid (EPA) toxicity
Correct Answer: B
Rationale: Linoleic acid (omega-6) is an essential fatty acid required for skin integrity,
wound healing, and cell membrane structure. TPN without lipid emulsions rapidly
depletes linoleic acid stores, causing essential fatty acid deficiency within 1-2 weeks.
Omega-3 deficiency is less common and presents differently; arachidonic acid can be
synthesized from linoleic acid.
Q8: A postoperative patient receiving only 5% dextrose in water IV has a serum
prealbumin of 12 mg/dL (normal 18-40 mg/dL) and 24-hour urine nitrogen of 18 g with
minimal nitrogen intake. Which nitrogen balance status is present?
A. Positive nitrogen balance indicating anabolism
B. Nitrogen equilibrium with balanced intake and output
C. Negative nitrogen balance indicating catabolism and tissue breakdown [CORRECT]
D. Nitrogen balance cannot be determined from these data
Correct Answer: C
Rationale: Negative nitrogen balance occurs when nitrogen excretion exceeds intake,
indicating catabolism, tissue breakdown, and inadequate protein intake. This is
common post-surgery due to metabolic stress. Positive balance occurs during growth
or recovery; equilibrium indicates adequate protein intake matching losses.
Q9: A patient with metabolic syndrome asks about dietary fat recommendations. Which
type of fatty acid should be MINIMIZED to reduce cardiovascular disease risk?
A. Monounsaturated fatty acids from olive oil and avocados
