C O M P R E H E N S I V E P R A C T I C E E X A M I N AT I O N
HESI NUTRITION EXAM
COMPREHENSIVE PRACTICE – 2026/2027 EDITION
150 Questions 8 Content Sections Answers & Rationales 5 Integrated Case Studies
I M P O RTA N T N O T I C E
This is an original practice examination written in the style of nursing nutrition
specialty exams. It is not an actual HESI assessment, is not affiliated with or endorsed by
Elsevier / Health Education Systems Incorporated (HESI), and contains no proprietary
exam items. It is intended for self-study and preparation only.
Clinical content is aligned with widely accepted guidance as of August 2026 — the most
recent published USDA/HHS Dietary Guidelines for Americans, Academy of Nutrition and
Dietetics practice guidance, ASPEN/AND malnutrition criteria, and the current NCLEX-RN
test plan. Recommendations evolve: always verify against current official sources and your
program's references before clinical or classroom use.
HOW TO USE THIS EXAM
Work through each section sequentially. Correct answers are marked [CORRECT] with a
rationale after every question — cover the answer column or have a study partner quiz
you to convert this into a self-test. Sections 1–7 map to core content domains
(fundamentals, micronutrients, lifespan, medical nutrition therapy, enteral/parenteral
nutrition, assessment, and food–drug safety); Section 8 contains five integrated case
studies with linked questions for clinical-judgment practice.
CONTENTS
1. Section 1 Nutrition Fundamentals & Macronutrients – Carbs, Proteins, Fats, Digestion,
Metabolism (25 questions)
2. Section 2 Micronutrients & Hydration – Vitamins, Minerals, Electrolytes, Fluid Balance
(20 questions)
3. Section 3 Nutrition Across the Lifespan – Pregnancy, Infancy, Childhood, Geriatrics
(20 questions)
4. Section 4 Medical Nutrition Therapy – Diabetes, CVD, Renal, Hepatic, GI Disorders (25
questions)
5. Section 5 Clinical Nutrition – Enteral Nutrition, Parenteral Nutrition, Tube Feeding, TPN
(20 questions)
Page 1 of 43
, HESI Nutrition Exam —Comprehensive Practice (2026/2027 Edition)
6. Section 6 Nutrition Assessment & Screening – Anthropometrics, Biochemical Data,
Clinical Signs (15 questions)
7. Section 7 Food Safety, Supplements, & Pharmacology – Foodborne Illness, Food-Drug
Interactions (10 questions)
8. Section 8 Integrated Case Studies – Complex, Multi-System Nutritional Scenarios (15
questions)
Page 2 of 43
, HESI Nutrition Exam —Comprehensive Practice (2026/2027 Edition)
Section 1: Nutrition Fundamentals & Macronutrients – Carbs,
Proteins, Fats, Digestion, Metabolism (25 questions)
Q1: A nurse is teaching a patient about the energy content of foods. Which nutrient provides 9 kcal per
gram?
A. Carbohydrate
B. Protein
C. Fat [CORRECT]
D. Alcohol
Correct Answer: C
Rationale: Fat provides 9 kcal/g, carbohydrate and protein each provide 4 kcal/g, and alcohol provides 7
kcal/g; the density of fat explains why high-fat diets are calorie-dense.
Q2: A patient with hyperlipidemia asks which food to eat more of to help lower blood cholesterol. Which
food should the nurse recommend?
A. Oatmeal [CORRECT]
B. White rice
C. Lean pork
D. Butter
Correct Answer: A
Rationale: Oats are rich in soluble fiber, which binds cholesterol-rich bile acids and lowers serum
cholesterol; white rice and pork provide little soluble fiber, and butter is high in saturated fat.
Q3: Which statement best describes the glycemic index of a food?
A. The total grams of carbohydrate in one serving
B. The number of kilocalories the food provides
C. How quickly the food raises blood glucose compared with a reference food [CORRECT]
D. The percentage of the food that is digestible starch
Correct Answer: C
Rationale: The glycemic index measures the rate and magnitude of blood glucose rise after eating a
food relative to a reference; it is independent of total carbohydrate grams and calories.
Q4: A nurse explains complete proteins to a client following a vegetarian-style diet. Which food
provides all essential amino acids in the amounts needed?
A. Lentils
B. Peanut butter
C. Brown rice
D. Eggs [CORRECT]
Correct Answer: D
Rationale: Eggs (like meat, fish, dairy, and soy) are complete proteins; lentils, peanut butter, and rice
are incomplete proteins that must be combined with complementary plant foods.
Page 3 of 43
, HESI Nutrition Exam —Comprehensive Practice (2026/2027 Edition)
Q5: Which patient is expected to be in positive nitrogen balance?
A. A patient with major burns
B. A healthy growing adolescent [CORRECT]
C. A patient in septic shock
D. A patient with prolonged fasting
Correct Answer: B
Rationale: Positive nitrogen balance (intake exceeding excretion) reflects anabolism seen with growth,
pregnancy, and recovery; burns, sepsis, and fasting are catabolic states producing negative balance.
Q6: A patient with an extremely low-fat diet develops scaly dermatitis and poor wound healing. Which
deficiency does the nurse suspect?
A. Essential fatty acid deficiency [CORRECT]
B. Vitamin C deficiency
C. Iron deficiency
D. Excess fiber intake
Correct Answer: A
Rationale: Linoleic and alpha-linolenic acids are essential fatty acids whose deficiency produces scaly
dermatitis and impaired healing; vitamin C deficiency causes bleeding and poor healing but is linked to
fruit/vegetable deprivation, and iron deficiency causes anemia.
Q7: A nurse is teaching about saturated fat. Which food contains the highest amount of saturated fat
per serving?
A. Salmon
B. Olive oil
C. Butter [CORRECT]
D. Avocado
Correct Answer: C
Rationale: Butter is predominantly saturated fat, which raises LDL cholesterol; salmon, olive oil, and
avocado provide predominantly unsaturated fats.
Q8: Why should trans-fatty acids (partially hydrogenated oils) be avoided?
A. They lower HDL and have no effect on LDL
B. They are beneficial for cardiac health in small amounts
C. They lower both LDL and HDL cholesterol
D. They raise LDL cholesterol and lower HDL cholesterol [CORRECT]
Correct Answer: D
Rationale: Trans fats raise LDL while lowering protective HDL, increasing cardiovascular risk more than
saturated fat alone; they have no beneficial lipid effects.
Page 4 of 43
HESI NUTRITION EXAM
COMPREHENSIVE PRACTICE – 2026/2027 EDITION
150 Questions 8 Content Sections Answers & Rationales 5 Integrated Case Studies
I M P O RTA N T N O T I C E
This is an original practice examination written in the style of nursing nutrition
specialty exams. It is not an actual HESI assessment, is not affiliated with or endorsed by
Elsevier / Health Education Systems Incorporated (HESI), and contains no proprietary
exam items. It is intended for self-study and preparation only.
Clinical content is aligned with widely accepted guidance as of August 2026 — the most
recent published USDA/HHS Dietary Guidelines for Americans, Academy of Nutrition and
Dietetics practice guidance, ASPEN/AND malnutrition criteria, and the current NCLEX-RN
test plan. Recommendations evolve: always verify against current official sources and your
program's references before clinical or classroom use.
HOW TO USE THIS EXAM
Work through each section sequentially. Correct answers are marked [CORRECT] with a
rationale after every question — cover the answer column or have a study partner quiz
you to convert this into a self-test. Sections 1–7 map to core content domains
(fundamentals, micronutrients, lifespan, medical nutrition therapy, enteral/parenteral
nutrition, assessment, and food–drug safety); Section 8 contains five integrated case
studies with linked questions for clinical-judgment practice.
CONTENTS
1. Section 1 Nutrition Fundamentals & Macronutrients – Carbs, Proteins, Fats, Digestion,
Metabolism (25 questions)
2. Section 2 Micronutrients & Hydration – Vitamins, Minerals, Electrolytes, Fluid Balance
(20 questions)
3. Section 3 Nutrition Across the Lifespan – Pregnancy, Infancy, Childhood, Geriatrics
(20 questions)
4. Section 4 Medical Nutrition Therapy – Diabetes, CVD, Renal, Hepatic, GI Disorders (25
questions)
5. Section 5 Clinical Nutrition – Enteral Nutrition, Parenteral Nutrition, Tube Feeding, TPN
(20 questions)
Page 1 of 43
, HESI Nutrition Exam —Comprehensive Practice (2026/2027 Edition)
6. Section 6 Nutrition Assessment & Screening – Anthropometrics, Biochemical Data,
Clinical Signs (15 questions)
7. Section 7 Food Safety, Supplements, & Pharmacology – Foodborne Illness, Food-Drug
Interactions (10 questions)
8. Section 8 Integrated Case Studies – Complex, Multi-System Nutritional Scenarios (15
questions)
Page 2 of 43
, HESI Nutrition Exam —Comprehensive Practice (2026/2027 Edition)
Section 1: Nutrition Fundamentals & Macronutrients – Carbs,
Proteins, Fats, Digestion, Metabolism (25 questions)
Q1: A nurse is teaching a patient about the energy content of foods. Which nutrient provides 9 kcal per
gram?
A. Carbohydrate
B. Protein
C. Fat [CORRECT]
D. Alcohol
Correct Answer: C
Rationale: Fat provides 9 kcal/g, carbohydrate and protein each provide 4 kcal/g, and alcohol provides 7
kcal/g; the density of fat explains why high-fat diets are calorie-dense.
Q2: A patient with hyperlipidemia asks which food to eat more of to help lower blood cholesterol. Which
food should the nurse recommend?
A. Oatmeal [CORRECT]
B. White rice
C. Lean pork
D. Butter
Correct Answer: A
Rationale: Oats are rich in soluble fiber, which binds cholesterol-rich bile acids and lowers serum
cholesterol; white rice and pork provide little soluble fiber, and butter is high in saturated fat.
Q3: Which statement best describes the glycemic index of a food?
A. The total grams of carbohydrate in one serving
B. The number of kilocalories the food provides
C. How quickly the food raises blood glucose compared with a reference food [CORRECT]
D. The percentage of the food that is digestible starch
Correct Answer: C
Rationale: The glycemic index measures the rate and magnitude of blood glucose rise after eating a
food relative to a reference; it is independent of total carbohydrate grams and calories.
Q4: A nurse explains complete proteins to a client following a vegetarian-style diet. Which food
provides all essential amino acids in the amounts needed?
A. Lentils
B. Peanut butter
C. Brown rice
D. Eggs [CORRECT]
Correct Answer: D
Rationale: Eggs (like meat, fish, dairy, and soy) are complete proteins; lentils, peanut butter, and rice
are incomplete proteins that must be combined with complementary plant foods.
Page 3 of 43
, HESI Nutrition Exam —Comprehensive Practice (2026/2027 Edition)
Q5: Which patient is expected to be in positive nitrogen balance?
A. A patient with major burns
B. A healthy growing adolescent [CORRECT]
C. A patient in septic shock
D. A patient with prolonged fasting
Correct Answer: B
Rationale: Positive nitrogen balance (intake exceeding excretion) reflects anabolism seen with growth,
pregnancy, and recovery; burns, sepsis, and fasting are catabolic states producing negative balance.
Q6: A patient with an extremely low-fat diet develops scaly dermatitis and poor wound healing. Which
deficiency does the nurse suspect?
A. Essential fatty acid deficiency [CORRECT]
B. Vitamin C deficiency
C. Iron deficiency
D. Excess fiber intake
Correct Answer: A
Rationale: Linoleic and alpha-linolenic acids are essential fatty acids whose deficiency produces scaly
dermatitis and impaired healing; vitamin C deficiency causes bleeding and poor healing but is linked to
fruit/vegetable deprivation, and iron deficiency causes anemia.
Q7: A nurse is teaching about saturated fat. Which food contains the highest amount of saturated fat
per serving?
A. Salmon
B. Olive oil
C. Butter [CORRECT]
D. Avocado
Correct Answer: C
Rationale: Butter is predominantly saturated fat, which raises LDL cholesterol; salmon, olive oil, and
avocado provide predominantly unsaturated fats.
Q8: Why should trans-fatty acids (partially hydrogenated oils) be avoided?
A. They lower HDL and have no effect on LDL
B. They are beneficial for cardiac health in small amounts
C. They lower both LDL and HDL cholesterol
D. They raise LDL cholesterol and lower HDL cholesterol [CORRECT]
Correct Answer: D
Rationale: Trans fats raise LDL while lowering protective HDL, increasing cardiovascular risk more than
saturated fat alone; they have no beneficial lipid effects.
Page 4 of 43
