ATI RN Nutrition CMS Proctored Exam 2026/2027 – 180
Scenario-Based Questions and Correct Answers
Question 1
Domain: Nutritional Assessment
A nurse is screening a client for nutritional risk. Which of the following findings is an early
indicator of protein-calorie malnutrition?
A) Weight loss of 2% over 1 month
B) Serum albumin level of 3.2 g/dL
C) Decreased grip strength
D) Triceps skinfold thickness below the 50th percentile
Rationale: Decreased grip strength is an early and sensitive indicator of protein-calorie
malnutrition, reflecting reduced muscle function before significant anthropometric changes
occur. Weight loss greater than 5% over 1 month is a more established criterion for significant
malnutrition. Albumin has a long half-life and is not an early indicator. Triceps skinfold thickness
measures fat stores, which are depleted later in malnutrition.
Question 2
Domain: Nutritional Assessment
A nurse is evaluating a client's laboratory results. Which of the following findings indicates a risk
for malnutrition?
A) Hemoglobin 14.2 g/dL
B) Prealbumin 12 mg/dL
C) Total lymphocyte count 2,500 cells/mm³
D) Serum transferrin 250 mg/dL
Rationale: Prealbumin, with a half-life of 2-3 days, is a sensitive marker for acute nutritional
changes; a normal level is 15-36 mg/dL, so 12 mg/dL indicates risk. Hemoglobin of 14.2 g/dL is
normal for an adult male but may be low for a female, however it is not a specific indicator of
malnutrition. A total lymphocyte count below 1,500 cells/mm³ indicates risk, so 2,500 is normal.
Transferrin is an iron transport protein; a level of 250 mg/dL is within the normal range (200-
360 mg/dL).
,Question 3
Domain: Nutritional Assessment
A nurse is preparing to perform a nutritional assessment on a newly admitted client. Which of
the following components is part of the Subjective Global Assessment (SGA)?
A) Serum albumin level
B) Weight history and dietary intake changes
C) Anthropometric measurements only
D) Calculation of nitrogen balance
Rationale: The Subjective Global Assessment (SGA) is a clinical tool that uses a focused history
(weight history, dietary intake, GI symptoms, functional capacity) and a brief physical exam
(muscle wasting, fat loss, edema) to assess nutritional status. It does not include laboratory
values like albumin or nitrogen balance, and while it includes physical exam, it is not limited to
anthropometric measurements.
Question 4
Domain: Nutritional Assessment
A nurse is calculating a client's BMI. The client weighs 88 kg and is 1.75 meters tall. What is the
client's BMI?
A) 25.1
B) 28.7
C) 30.2
D) 32.4
Rationale: BMI is calculated as weight in kilograms divided by height in meters squared. 88 kg /
(1.75 m)² = .0625 = 28.7. A BMI of 28.7 falls in the overweight category (25-29.9).
Question 5
Domain: Nutritional Assessment
A nurse is assessing a client for signs of malnutrition. Which of the following physical
examination findings is associated with protein deficiency?
A) Bitot's spots
B) Glossitis
C) Edema
,D) Follicular hyperkeratosis
Rationale: Edema is a sign of protein deficiency due to decreased oncotic pressure from low
serum albumin. Bitot's spots are associated with vitamin A deficiency. Glossitis is associated
with B-vitamin deficiencies (e.g., riboflavin, niacin, B12). Follicular hyperkeratosis is associated
with vitamin A or essential fatty acid deficiency.
Question 6
Domain: Nutritional Assessment
A nurse is reviewing the dietary intake of a client who follows a vegan diet. The nurse should
recommend which of the following foods to ensure adequate intake of vitamin B12?
A) Fortified soy milk
B) Spinach
C) Citrus fruits
D) Whole grains
Rationale: Vitamin B12 is primarily found in animal products. Fortified soy milk and other
fortified plant-based milks are reliable sources for individuals following a vegan diet. Spinach is a
source of iron and folate. Citrus fruits are a source of vitamin C. Whole grains are a source of B
vitamins, but not typically B12.
Question 7
Domain: Nutritional Assessment
A nurse is assessing a client's risk for malnutrition using the Mini Nutritional Assessment (MNA).
Which of the following clients is most appropriate for this screening tool?
A) A 25-year-old pregnant client
B) A 70-year-old client living in a long-term care facility
C) A 45-year-old client with a sports injury
D) A 10-year-old child with cystic fibrosis
Rationale: The Mini Nutritional Assessment (MNA) is specifically designed and validated for use
in older adults (typically 65 years and older) to screen for malnutrition risk. It is not intended for
use in pregnant women, children, or young adults with acute injuries.
Question 8
Domain: Nutritional Assessment
, A nurse is teaching a client about dietary sources of calcium. Which of the following foods
should the nurse include as having the highest bioavailability of calcium?
A) Milk
B) Spinach
C) Kale
D) Fortified orange juice
Rationale: Dairy products like milk have a high calcium content and excellent bioavailability.
While spinach contains calcium, it also contains oxalates, which bind calcium and reduce its
absorption. Kale is a good source with moderate bioavailability. Fortified orange juice has added
calcium, but its bioavailability is generally lower than dairy.
Question 9
Domain: Gastrointestinal/Nutrition
A nurse is providing dietary teaching to a client with a new diagnosis of celiac disease. Which of
the following foods should the nurse instruct the client to avoid?
A) Rice
B) Quinoa
C) Barley
D) Corn
Rationale: Celiac disease is an autoimmune disorder triggered by gluten, a protein found in
wheat, barley, and rye. Barley contains gluten and must be avoided. Rice, quinoa (if certified
gluten-free), and corn are generally safe gluten-free grains.
Question 10
Domain: Gastrointestinal/Nutrition
A nurse is caring for a client who had a gastrectomy. The client reports experiencing diaphoresis,
weakness, and palpitations 30 minutes after eating. The nurse should identify these findings as
indicative of which of the following complications?
A) Dumping syndrome
B) Gastric outlet obstruction
C) Peritonitis
D) Pyloric stenosis
Scenario-Based Questions and Correct Answers
Question 1
Domain: Nutritional Assessment
A nurse is screening a client for nutritional risk. Which of the following findings is an early
indicator of protein-calorie malnutrition?
A) Weight loss of 2% over 1 month
B) Serum albumin level of 3.2 g/dL
C) Decreased grip strength
D) Triceps skinfold thickness below the 50th percentile
Rationale: Decreased grip strength is an early and sensitive indicator of protein-calorie
malnutrition, reflecting reduced muscle function before significant anthropometric changes
occur. Weight loss greater than 5% over 1 month is a more established criterion for significant
malnutrition. Albumin has a long half-life and is not an early indicator. Triceps skinfold thickness
measures fat stores, which are depleted later in malnutrition.
Question 2
Domain: Nutritional Assessment
A nurse is evaluating a client's laboratory results. Which of the following findings indicates a risk
for malnutrition?
A) Hemoglobin 14.2 g/dL
B) Prealbumin 12 mg/dL
C) Total lymphocyte count 2,500 cells/mm³
D) Serum transferrin 250 mg/dL
Rationale: Prealbumin, with a half-life of 2-3 days, is a sensitive marker for acute nutritional
changes; a normal level is 15-36 mg/dL, so 12 mg/dL indicates risk. Hemoglobin of 14.2 g/dL is
normal for an adult male but may be low for a female, however it is not a specific indicator of
malnutrition. A total lymphocyte count below 1,500 cells/mm³ indicates risk, so 2,500 is normal.
Transferrin is an iron transport protein; a level of 250 mg/dL is within the normal range (200-
360 mg/dL).
,Question 3
Domain: Nutritional Assessment
A nurse is preparing to perform a nutritional assessment on a newly admitted client. Which of
the following components is part of the Subjective Global Assessment (SGA)?
A) Serum albumin level
B) Weight history and dietary intake changes
C) Anthropometric measurements only
D) Calculation of nitrogen balance
Rationale: The Subjective Global Assessment (SGA) is a clinical tool that uses a focused history
(weight history, dietary intake, GI symptoms, functional capacity) and a brief physical exam
(muscle wasting, fat loss, edema) to assess nutritional status. It does not include laboratory
values like albumin or nitrogen balance, and while it includes physical exam, it is not limited to
anthropometric measurements.
Question 4
Domain: Nutritional Assessment
A nurse is calculating a client's BMI. The client weighs 88 kg and is 1.75 meters tall. What is the
client's BMI?
A) 25.1
B) 28.7
C) 30.2
D) 32.4
Rationale: BMI is calculated as weight in kilograms divided by height in meters squared. 88 kg /
(1.75 m)² = .0625 = 28.7. A BMI of 28.7 falls in the overweight category (25-29.9).
Question 5
Domain: Nutritional Assessment
A nurse is assessing a client for signs of malnutrition. Which of the following physical
examination findings is associated with protein deficiency?
A) Bitot's spots
B) Glossitis
C) Edema
,D) Follicular hyperkeratosis
Rationale: Edema is a sign of protein deficiency due to decreased oncotic pressure from low
serum albumin. Bitot's spots are associated with vitamin A deficiency. Glossitis is associated
with B-vitamin deficiencies (e.g., riboflavin, niacin, B12). Follicular hyperkeratosis is associated
with vitamin A or essential fatty acid deficiency.
Question 6
Domain: Nutritional Assessment
A nurse is reviewing the dietary intake of a client who follows a vegan diet. The nurse should
recommend which of the following foods to ensure adequate intake of vitamin B12?
A) Fortified soy milk
B) Spinach
C) Citrus fruits
D) Whole grains
Rationale: Vitamin B12 is primarily found in animal products. Fortified soy milk and other
fortified plant-based milks are reliable sources for individuals following a vegan diet. Spinach is a
source of iron and folate. Citrus fruits are a source of vitamin C. Whole grains are a source of B
vitamins, but not typically B12.
Question 7
Domain: Nutritional Assessment
A nurse is assessing a client's risk for malnutrition using the Mini Nutritional Assessment (MNA).
Which of the following clients is most appropriate for this screening tool?
A) A 25-year-old pregnant client
B) A 70-year-old client living in a long-term care facility
C) A 45-year-old client with a sports injury
D) A 10-year-old child with cystic fibrosis
Rationale: The Mini Nutritional Assessment (MNA) is specifically designed and validated for use
in older adults (typically 65 years and older) to screen for malnutrition risk. It is not intended for
use in pregnant women, children, or young adults with acute injuries.
Question 8
Domain: Nutritional Assessment
, A nurse is teaching a client about dietary sources of calcium. Which of the following foods
should the nurse include as having the highest bioavailability of calcium?
A) Milk
B) Spinach
C) Kale
D) Fortified orange juice
Rationale: Dairy products like milk have a high calcium content and excellent bioavailability.
While spinach contains calcium, it also contains oxalates, which bind calcium and reduce its
absorption. Kale is a good source with moderate bioavailability. Fortified orange juice has added
calcium, but its bioavailability is generally lower than dairy.
Question 9
Domain: Gastrointestinal/Nutrition
A nurse is providing dietary teaching to a client with a new diagnosis of celiac disease. Which of
the following foods should the nurse instruct the client to avoid?
A) Rice
B) Quinoa
C) Barley
D) Corn
Rationale: Celiac disease is an autoimmune disorder triggered by gluten, a protein found in
wheat, barley, and rye. Barley contains gluten and must be avoided. Rice, quinoa (if certified
gluten-free), and corn are generally safe gluten-free grains.
Question 10
Domain: Gastrointestinal/Nutrition
A nurse is caring for a client who had a gastrectomy. The client reports experiencing diaphoresis,
weakness, and palpitations 30 minutes after eating. The nurse should identify these findings as
indicative of which of the following complications?
A) Dumping syndrome
B) Gastric outlet obstruction
C) Peritonitis
D) Pyloric stenosis
