ATI RN NUTRITION
COMPREHENSIVE PROCTORED EXAM
2025/2026
Part 1: Questions 1-35
Nutritional Assessment, Macronutrients & Therapeutic Diets
Proctored Exam Study Guide | Latest 2025/2026 Update
Exam Questions with Correct Answers and Rationales
Aligned with 2025|2026 ATI Testing Standards
Academy of Nutrition and Dietetics (AND) & ASPEN Guidelines
WHO Nutrition Reference Standards
NCSBN Clinical Judgment Measurement Model (NCJMM)
Total Questions (Part 1): 35
Cognitive Levels: 30% Recall | 50% Application | 20% Analysis
Question Types: 75% Scenario-Based | 25% Direct Knowledge
Date: April 2026
Aligned with AND, ASPEN & WHO Nutrition Guidelines | Cognitive Levels: Recall / Application / Analysis
,ATI RN Nutrition Comprehensive Proctored Exam 2025/2026 | Part 1: Questions 1-35 Page 2
Abstract
This examination review comprises the first 35 multiple-choice questions of a comprehensive ATI RN Nutrition Proctored Exam
aligned with the 2025/2026 ATI testing blueprint and current AND, ASPEN, and WHO nutrition guidelines. The examination spans
three core domains: Nutritional Assessment, Screening Tools & Data Interpretation (Questions 1-10) covering BMI calculation,
MUST/MNA screening tools, laboratory value interpretation (albumin, prealbumin, transferrin), anthropometric measurements, and
malnutrition risk identification across med-surg, pediatric, obstetric, geriatric, and community populations; Macronutrients,
Micronutrients & Metabolic Pathways (Questions 11-22) addressing protein-energy metabolism, vitamin and mineral functions,
deficiency and toxicity presentations, fluid and electrolyte balance, and supplementation protocols; and Therapeutic Diets including
Cardiac, Renal, Diabetic, GI & Oncology Nutrition (Questions 23-35) evaluating DASH diet principles, renal diet modifications, diabetic
exchange systems, low-residue diets, neutropenic precautions, ketogenic diet management, and nutrition support in cancer care.
Approximately 75% of questions employ scenario-based clinical nutrition vignettes requiring dietary assessment reasoning, lab value
correlation, patient education evaluation, and priority action determination. Cognitive levels are distributed as 30% recall, 50%
application, and 20% analysis to reflect NCLEX-RN examination standards.
Keywords: ATI Nutrition, NCLEX-RN, BMI, MUST Screening, MNA, Albumin, Prealbumin, Macronutrients, Micronutrients,
DASH Diet, Renal Diet, Diabetic Exchange, Neutropenic Diet, Ketogenic Diet, ASPEN, AND, WHO Nutrition Guidelines
Examination Blueprint - Part 1
Sec Domain Q Range Count Cognitive Level
1 Nutritional Assessment, Screening Tools& Data Interpretation Q1-Q10 10 30% Recall / 50% App / 20% An
2 Macronutrients, Micronutrients& Metabolic Pathways Q11-Q22 12 30% Recall / 50% App / 20% An
3 Therapeutic Diets: Cardiac, Renal,Diabetic, GI & Oncology Nutrition Q23-Q35 13 30% Recall / 50% App / 20% An
Total 35
Aligned with AND, ASPEN & WHO Nutrition Guidelines | Cognitive Levels: Recall / Application / Analysis
,ATI RN Nutrition Comprehensive Proctored Exam 2025/2026 | Part 1: Questions 1-35 Page 3
Section 1: Nutritional Assessment, Screening Tools & Data Interpretation
(Q1-Q10)
This section covers BMI calculation and WHO weight classification, MUST (Malnutrition Universal Screening Tool) and MNA (Mini Nutritional
Assessment) screening tools, laboratory value interpretation (albumin, prealbumin, transferrin, CRP), anthropometric measurements across
the lifespan (pediatric growth charts, geriatric assessment), 24-hour dietary recall and food diary analysis, intake/output records, calorie count
evaluation, malnutrition risk identification across med-surg, pediatric, obstetric, geriatric, and community populations. References: AND
Nutrition Care Manual, ASPEN Guidelines, WHO BMI Classification, NPUAP/EPUAP Standards.
Q1: A nurse is calculating the body mass index (BMI) for a 38-year-old male client who weighs 205 lb and is 5 feet 9
inches tall. What is this client's BMI, and how should the nurse classify his weight status?
A. BMI 28.4; classified as overweight per WHO guidelines
B. BMI 30.2; classified as obese class I per WHO guidelines [CORRECT]
C. BMI 25.8; classified as normal weight per WHO guidelines
D. BMI 32.6; classified as obese class II per WHO guidelines
Correct Answer: B
Rationale: BMI = weight(kg) / height(m)^2. Converting: 205 lb = 93.0 kg, 5'9" = 1.75 m. BMI = 93.0 / (1.75)^2 = 93..0625 = 30.4. A BMI
of 30.0-34.9 is classified as obese class I per WHO criteria. Option A uses an incorrect conversion factor, option C is a calculation error,
and option D overestimates the BMI.
Q2: A nurse in a medical-surgical unit is performing the Malnutrition Universal Screening Tool (MUST) on a
72-year-old female client admitted for pneumonia. She reports a 12 lb weight loss over the past 4 months and has
been eating poorly due to anorexia. Her current BMI is 19.1 kg/m2. What is her MUST score and the appropriate
nursing action?
A. MUST score = 1 (medium risk); initiate weekly food intake monitoring and refer to dietitian within 1 week
B. MUST score = 2 (high risk); initiate nutrition support and refer to dietitian immediately [CORRECT]
C. MUST score = 0 (low risk); document findings and continue current dietary pattern
D. MUST score = 3 (high risk); initiate enteral nutrition supplementation and daily calorie counts
Correct Answer: B
Rationale: MUST scoring: Step 1 (BMI): BMI 18.5-20 = score 1; Step 2 (unplanned weight loss in 3-6 months): 12 lb is approximately
5-10% loss = score 1; Step 3 (acute disease effect): pneumonia with poor intake = score 1 (likely nil by mouth or reduced intake >5 days).
Total = 2 (high risk). High-risk patients require immediate dietitian referral and nutrition support intervention. Option A underestimates,
option C misses the risk entirely, and option D overestimates by assigning a score of 3 for a scenario warranting 2.
Q3: A nurse is reviewing the laboratory results for a 55-year-old client recovering from a severe burn injury covering
35% total body surface area (TBSA). The prealbumin level is 8 mg/dL (reference: 15-35 mg/dL), albumin is 2.8 g/dL,
and CRP is elevated at 24 mg/L. The client has been receiving enteral nutrition at goal for 7 days. Which interpretation
by the nurse is most accurate?
A. The prealbumin level indicates the enteral nutrition is inadequate and must be increased by 50% to correct malnutrition
B. The elevated CRP is an acute-phase reactant that falsely elevates prealbumin, so the client is likely not malnourished
C. The prealbumin is a valid indicator of malnutrition in this client because it has a short half-life of 2 days and responds quickly to
nutrition changes
D. The elevated CRP is an acute-phase reactant that suppresses prealbumin synthesis, making it unreliable as a nutrition
marker during acute inflammation [CORRECT]
Correct Answer: D
Rationale: Prealbumin (transthyretin) is a negative acute-phase reactant, meaning its synthesis is suppressed during inflammatory states
due to elevated CRP and cytokines. Despite adequate enteral nutrition for 7 days, the low prealbumin of 8 mg/dL reflects
Aligned with AND, ASPEN & WHO Nutrition Guidelines | Cognitive Levels: Recall / Application / Analysis
, ATI RN Nutrition Comprehensive Proctored Exam 2025/2026 | Part 1: Questions 1-35 Page 4
inflammation-related suppression rather than true malnutrition. ASPEN guidelines recommend using serial prealbumin trends only when
inflammation is resolving (CRP trending down). Option A is incorrect because increasing calories will not overcome inflammation-driven
suppression; option B incorrectly states CRP elevates prealbumin; option C ignores the confounding inflammatory effect.
Q4: A community health nurse is assessing a 14-month-old infant during a well-child visit. The infant's weight is at
the 5th percentile, length at the 40th percentile, and head circumference at the 45th percentile. The infant's weight at 6
months was at the 50th percentile. Which finding is the priority concern for the nurse to report to the provider?
A. The head circumference percentile suggests possible microcephaly requiring neurologic evaluation
B. The disproportionate drop in weight percentile with maintained linear growth indicates acute malnutrition or failure to
thrive [CORRECT]
C. The length-to-weight ratio is appropriate for age and the infant is likely constitutionally small
D. The infant should be referred for genetic testing due to the discrepancy between length and weight percentiles
Correct Answer: B
Rationale: This infant demonstrates a classic pattern of acute malnutrition or failure to thrive: weight percentile has dropped from the 50th
to 5th percentile while linear growth (length) and head circumference are maintained. When weight declines disproportionately to length, it
indicates recent inadequate caloric intake (acute malnutrition). If both weight and length declined together, it would suggest chronic
malnutrition. Head circumference is preserved, which is a reassuring sign that brain growth is not yet affected. Option A is incorrect
because head circumference at the 45th percentile is normal; option C dismisses a significant weight falloff; option D is an overreaction
without supporting evidence.
Q5: A nurse educator is presenting a seminar on nutrition screening to a group of new graduate nurses. Which
statement by a new nurse indicates the need for further education regarding laboratory markers of nutritional status?
A. Albumin has a long half-life of approximately 20 days, making it a poor indicator of short-term nutritional changes
B. Serum albumin levels are significantly affected by inflammation, hydration status, and liver disease independent of nutrition
C. An albumin level below 3.0 g/dL strongly indicates the client has been malnourished for at least the past 1-2 weeks
[CORRECT]
D. Prealbumin has a half-life of 2-3 days and is more responsive to recent changes in nutritional intake than albumin
Correct Answer: C
Rationale: Albumin has a half-life of approximately 18-20 days, so a low albumin level reflects long-term nutritional depletion (weeks to
months), not 1-2 weeks. Additionally, albumin is heavily influenced by non-nutritional factors including inflammation, liver disease,
nephrotic syndrome, and fluid shifts, making it an unreliable standalone marker of nutritional status. Options A, B, and D are all accurate
statements reflecting current AND and ASPEN guidelines on nutrition assessment laboratory markers.
Q6: A nurse is completing the Mini Nutritional Assessment (MNA) for an 84-year-old long-term care resident. The
resident has a BMI of 17.8 kg/m2, lives alone, eats two meals per day, has lost 4 kg in the past 3 months, reports
occasional forgetfulness during meals, has reduced mobility, and has mild dementia. What MNA screening score
category does this resident fall into, and what is the priority nursing intervention?
A. Normal nutritional status (MNA score 12-14); encourage continued current dietary pattern and monitor at next scheduled
assessment
B. At risk of malnutrition (MNA score 8-11); implement dietary modifications, offer snacks between meals, and reassess in 1
month
C. Malnourished (MNA score 0-7); initiate comprehensive nutritional intervention including fortified foods, oral
supplements, and dietitian referral [CORRECT]
D. At risk of malnutrition (MNA score 8-11); the cognitive impairment is the primary concern and nutritional interventions are not
yet indicated
Correct Answer: C
Rationale: Using the MNA-SF (Short Form), scoring points: BMI < 19 = 0 points; weight loss > 3 kg in 3 months = 0 points; mobility =
reduced/wheelchair (1 point); psychological stress/dementia = 1 point; meals per day = 2 meals (0 points). MNA-SF total = 0 + 0 + 1 + 1 +
0 = 2 points (or with full MNA considering additional factors, also scores in malnourished range). An MNA score of 0-7 indicates
Aligned with AND, ASPEN & WHO Nutrition Guidelines | Cognitive Levels: Recall / Application / Analysis
COMPREHENSIVE PROCTORED EXAM
2025/2026
Part 1: Questions 1-35
Nutritional Assessment, Macronutrients & Therapeutic Diets
Proctored Exam Study Guide | Latest 2025/2026 Update
Exam Questions with Correct Answers and Rationales
Aligned with 2025|2026 ATI Testing Standards
Academy of Nutrition and Dietetics (AND) & ASPEN Guidelines
WHO Nutrition Reference Standards
NCSBN Clinical Judgment Measurement Model (NCJMM)
Total Questions (Part 1): 35
Cognitive Levels: 30% Recall | 50% Application | 20% Analysis
Question Types: 75% Scenario-Based | 25% Direct Knowledge
Date: April 2026
Aligned with AND, ASPEN & WHO Nutrition Guidelines | Cognitive Levels: Recall / Application / Analysis
,ATI RN Nutrition Comprehensive Proctored Exam 2025/2026 | Part 1: Questions 1-35 Page 2
Abstract
This examination review comprises the first 35 multiple-choice questions of a comprehensive ATI RN Nutrition Proctored Exam
aligned with the 2025/2026 ATI testing blueprint and current AND, ASPEN, and WHO nutrition guidelines. The examination spans
three core domains: Nutritional Assessment, Screening Tools & Data Interpretation (Questions 1-10) covering BMI calculation,
MUST/MNA screening tools, laboratory value interpretation (albumin, prealbumin, transferrin), anthropometric measurements, and
malnutrition risk identification across med-surg, pediatric, obstetric, geriatric, and community populations; Macronutrients,
Micronutrients & Metabolic Pathways (Questions 11-22) addressing protein-energy metabolism, vitamin and mineral functions,
deficiency and toxicity presentations, fluid and electrolyte balance, and supplementation protocols; and Therapeutic Diets including
Cardiac, Renal, Diabetic, GI & Oncology Nutrition (Questions 23-35) evaluating DASH diet principles, renal diet modifications, diabetic
exchange systems, low-residue diets, neutropenic precautions, ketogenic diet management, and nutrition support in cancer care.
Approximately 75% of questions employ scenario-based clinical nutrition vignettes requiring dietary assessment reasoning, lab value
correlation, patient education evaluation, and priority action determination. Cognitive levels are distributed as 30% recall, 50%
application, and 20% analysis to reflect NCLEX-RN examination standards.
Keywords: ATI Nutrition, NCLEX-RN, BMI, MUST Screening, MNA, Albumin, Prealbumin, Macronutrients, Micronutrients,
DASH Diet, Renal Diet, Diabetic Exchange, Neutropenic Diet, Ketogenic Diet, ASPEN, AND, WHO Nutrition Guidelines
Examination Blueprint - Part 1
Sec Domain Q Range Count Cognitive Level
1 Nutritional Assessment, Screening Tools& Data Interpretation Q1-Q10 10 30% Recall / 50% App / 20% An
2 Macronutrients, Micronutrients& Metabolic Pathways Q11-Q22 12 30% Recall / 50% App / 20% An
3 Therapeutic Diets: Cardiac, Renal,Diabetic, GI & Oncology Nutrition Q23-Q35 13 30% Recall / 50% App / 20% An
Total 35
Aligned with AND, ASPEN & WHO Nutrition Guidelines | Cognitive Levels: Recall / Application / Analysis
,ATI RN Nutrition Comprehensive Proctored Exam 2025/2026 | Part 1: Questions 1-35 Page 3
Section 1: Nutritional Assessment, Screening Tools & Data Interpretation
(Q1-Q10)
This section covers BMI calculation and WHO weight classification, MUST (Malnutrition Universal Screening Tool) and MNA (Mini Nutritional
Assessment) screening tools, laboratory value interpretation (albumin, prealbumin, transferrin, CRP), anthropometric measurements across
the lifespan (pediatric growth charts, geriatric assessment), 24-hour dietary recall and food diary analysis, intake/output records, calorie count
evaluation, malnutrition risk identification across med-surg, pediatric, obstetric, geriatric, and community populations. References: AND
Nutrition Care Manual, ASPEN Guidelines, WHO BMI Classification, NPUAP/EPUAP Standards.
Q1: A nurse is calculating the body mass index (BMI) for a 38-year-old male client who weighs 205 lb and is 5 feet 9
inches tall. What is this client's BMI, and how should the nurse classify his weight status?
A. BMI 28.4; classified as overweight per WHO guidelines
B. BMI 30.2; classified as obese class I per WHO guidelines [CORRECT]
C. BMI 25.8; classified as normal weight per WHO guidelines
D. BMI 32.6; classified as obese class II per WHO guidelines
Correct Answer: B
Rationale: BMI = weight(kg) / height(m)^2. Converting: 205 lb = 93.0 kg, 5'9" = 1.75 m. BMI = 93.0 / (1.75)^2 = 93..0625 = 30.4. A BMI
of 30.0-34.9 is classified as obese class I per WHO criteria. Option A uses an incorrect conversion factor, option C is a calculation error,
and option D overestimates the BMI.
Q2: A nurse in a medical-surgical unit is performing the Malnutrition Universal Screening Tool (MUST) on a
72-year-old female client admitted for pneumonia. She reports a 12 lb weight loss over the past 4 months and has
been eating poorly due to anorexia. Her current BMI is 19.1 kg/m2. What is her MUST score and the appropriate
nursing action?
A. MUST score = 1 (medium risk); initiate weekly food intake monitoring and refer to dietitian within 1 week
B. MUST score = 2 (high risk); initiate nutrition support and refer to dietitian immediately [CORRECT]
C. MUST score = 0 (low risk); document findings and continue current dietary pattern
D. MUST score = 3 (high risk); initiate enteral nutrition supplementation and daily calorie counts
Correct Answer: B
Rationale: MUST scoring: Step 1 (BMI): BMI 18.5-20 = score 1; Step 2 (unplanned weight loss in 3-6 months): 12 lb is approximately
5-10% loss = score 1; Step 3 (acute disease effect): pneumonia with poor intake = score 1 (likely nil by mouth or reduced intake >5 days).
Total = 2 (high risk). High-risk patients require immediate dietitian referral and nutrition support intervention. Option A underestimates,
option C misses the risk entirely, and option D overestimates by assigning a score of 3 for a scenario warranting 2.
Q3: A nurse is reviewing the laboratory results for a 55-year-old client recovering from a severe burn injury covering
35% total body surface area (TBSA). The prealbumin level is 8 mg/dL (reference: 15-35 mg/dL), albumin is 2.8 g/dL,
and CRP is elevated at 24 mg/L. The client has been receiving enteral nutrition at goal for 7 days. Which interpretation
by the nurse is most accurate?
A. The prealbumin level indicates the enteral nutrition is inadequate and must be increased by 50% to correct malnutrition
B. The elevated CRP is an acute-phase reactant that falsely elevates prealbumin, so the client is likely not malnourished
C. The prealbumin is a valid indicator of malnutrition in this client because it has a short half-life of 2 days and responds quickly to
nutrition changes
D. The elevated CRP is an acute-phase reactant that suppresses prealbumin synthesis, making it unreliable as a nutrition
marker during acute inflammation [CORRECT]
Correct Answer: D
Rationale: Prealbumin (transthyretin) is a negative acute-phase reactant, meaning its synthesis is suppressed during inflammatory states
due to elevated CRP and cytokines. Despite adequate enteral nutrition for 7 days, the low prealbumin of 8 mg/dL reflects
Aligned with AND, ASPEN & WHO Nutrition Guidelines | Cognitive Levels: Recall / Application / Analysis
, ATI RN Nutrition Comprehensive Proctored Exam 2025/2026 | Part 1: Questions 1-35 Page 4
inflammation-related suppression rather than true malnutrition. ASPEN guidelines recommend using serial prealbumin trends only when
inflammation is resolving (CRP trending down). Option A is incorrect because increasing calories will not overcome inflammation-driven
suppression; option B incorrectly states CRP elevates prealbumin; option C ignores the confounding inflammatory effect.
Q4: A community health nurse is assessing a 14-month-old infant during a well-child visit. The infant's weight is at
the 5th percentile, length at the 40th percentile, and head circumference at the 45th percentile. The infant's weight at 6
months was at the 50th percentile. Which finding is the priority concern for the nurse to report to the provider?
A. The head circumference percentile suggests possible microcephaly requiring neurologic evaluation
B. The disproportionate drop in weight percentile with maintained linear growth indicates acute malnutrition or failure to
thrive [CORRECT]
C. The length-to-weight ratio is appropriate for age and the infant is likely constitutionally small
D. The infant should be referred for genetic testing due to the discrepancy between length and weight percentiles
Correct Answer: B
Rationale: This infant demonstrates a classic pattern of acute malnutrition or failure to thrive: weight percentile has dropped from the 50th
to 5th percentile while linear growth (length) and head circumference are maintained. When weight declines disproportionately to length, it
indicates recent inadequate caloric intake (acute malnutrition). If both weight and length declined together, it would suggest chronic
malnutrition. Head circumference is preserved, which is a reassuring sign that brain growth is not yet affected. Option A is incorrect
because head circumference at the 45th percentile is normal; option C dismisses a significant weight falloff; option D is an overreaction
without supporting evidence.
Q5: A nurse educator is presenting a seminar on nutrition screening to a group of new graduate nurses. Which
statement by a new nurse indicates the need for further education regarding laboratory markers of nutritional status?
A. Albumin has a long half-life of approximately 20 days, making it a poor indicator of short-term nutritional changes
B. Serum albumin levels are significantly affected by inflammation, hydration status, and liver disease independent of nutrition
C. An albumin level below 3.0 g/dL strongly indicates the client has been malnourished for at least the past 1-2 weeks
[CORRECT]
D. Prealbumin has a half-life of 2-3 days and is more responsive to recent changes in nutritional intake than albumin
Correct Answer: C
Rationale: Albumin has a half-life of approximately 18-20 days, so a low albumin level reflects long-term nutritional depletion (weeks to
months), not 1-2 weeks. Additionally, albumin is heavily influenced by non-nutritional factors including inflammation, liver disease,
nephrotic syndrome, and fluid shifts, making it an unreliable standalone marker of nutritional status. Options A, B, and D are all accurate
statements reflecting current AND and ASPEN guidelines on nutrition assessment laboratory markers.
Q6: A nurse is completing the Mini Nutritional Assessment (MNA) for an 84-year-old long-term care resident. The
resident has a BMI of 17.8 kg/m2, lives alone, eats two meals per day, has lost 4 kg in the past 3 months, reports
occasional forgetfulness during meals, has reduced mobility, and has mild dementia. What MNA screening score
category does this resident fall into, and what is the priority nursing intervention?
A. Normal nutritional status (MNA score 12-14); encourage continued current dietary pattern and monitor at next scheduled
assessment
B. At risk of malnutrition (MNA score 8-11); implement dietary modifications, offer snacks between meals, and reassess in 1
month
C. Malnourished (MNA score 0-7); initiate comprehensive nutritional intervention including fortified foods, oral
supplements, and dietitian referral [CORRECT]
D. At risk of malnutrition (MNA score 8-11); the cognitive impairment is the primary concern and nutritional interventions are not
yet indicated
Correct Answer: C
Rationale: Using the MNA-SF (Short Form), scoring points: BMI < 19 = 0 points; weight loss > 3 kg in 3 months = 0 points; mobility =
reduced/wheelchair (1 point); psychological stress/dementia = 1 point; meals per day = 2 meals (0 points). MNA-SF total = 0 + 0 + 1 + 1 +
0 = 2 points (or with full MNA considering additional factors, also scores in malnourished range). An MNA score of 0-7 indicates
Aligned with AND, ASPEN & WHO Nutrition Guidelines | Cognitive Levels: Recall / Application / Analysis
