GALEN COLLEGE OF NURSING
NSG 3100: Fundamental Concepts and Skills for Nursing Practice I
EXAM 4 FINAL FALL 2026
Question 1. A nurse is evaluating a 3-year-old child in a pediatric clinic. The child presents with generalized
edema, fluid retention, and a swollen abdomen, but has preserved subcutaneous fat and non -prominent ribs.
The parents report a diet consisting almost exclusively of low-protein carbohydrates. Which condition is
present?
A) Anorexia nervosa
B) Bulimia nervosa
C) Marasmus
Question 2. An infant under 1 year of age is admitted with severe emaciation, loss of subcutaneous fat, and
extremely prominent ribs. The infant's diet has lacked both adequate protein and overall calories. Which
nutritional alteration should the nurse document?
✔ A) Marasmus (Correct Answer)
B) Hyperphosphatemia
C) Metabolic acidosis
D) Kwashiorkor
✔ Clinical Rationale & Source Grounding:
Marasmus is characterized by a severe lack of both protein AND calories, most common in infants under 1 year old,
presenting with prominent ribs and loss of subcutaneous fat.
CONFIDENTIAL — GALEN 1 of 35 FALL 2026
,GALEN COLLEGE OF NURSING — NSG 3100 EXAM 4 FINAL (FALL 2026)
Question 3. Which key physical assessment feature differentiates Kwashiorkor from Marasmus in pediatric
patients?
✔ A) Preservation of subcutaneous fat and fluid retention in Kwashiorkor versus loss of
subcutaneous fat and prominent ribs in Marasmus. (Correct Answer)
B) Prominent ribs and severe wasting in Kwashiorkor versus generalized fluid retention in Marasmus.
C) Lack of calories only in Kwashiorkor versus lack of protein only in Marasmus.
D) Presence of tetany in Kwashiorkor versus positive Trousseau sign in Marasmus.
✔ Clinical Rationale & Source Grounding:
The course review explicitly notes that Kwashiorkor features fluid retention with preserved subcutaneous fat and
non-prominent ribs, whereas Marasmus features lack of protein AND calories with prominent ribs and absent
subcutaneous fat.
Question 4. When assessing social factors contributing to nutritional deficits in low-income families, which
primary barrier does the nurse identify?
A) Income leads to excessive accumulation of fat-soluble vitamins in liver tissue.
B) Income causes an involuntary elevation in basal metabolic rate.
✔ C) Income affects malnutrition due to lack of food distribution or access. (Correct Answer)
D) Income directly alters the absorption rate of water-soluble vitamins B and C.
✔ Clinical Rationale & Source Grounding:
The source material explicitly states under Chapter 30 that income can affect malnutrition because of a lack of
distribution or access.
Question 5. A nurse is performing a health history on a client living alone on a low fixed income. Which
dietary history risk factor places this client at heightened risk for malnutrition?
A) Regular consumption of monounsaturated fats and high-fiber foods
B) Daily weight monitoring causing rapid fluid volume expansion
C) Excessive daily intake of citrus fruits and white potatoes
Question 6. A nurse notes that a malnourished older adult living alone has a limited income. What is the
primary clinical consequence of this social risk factor?
A) Immediate breakdown of central venous catheter access sites
B) Development of hypermagnesemia secondary to dehydration
✔ C) Inability to purchase nutrient-dense foods required to meet essential body needs (Correct
Answer)
D) Hyperactive deep tendon reflexes caused by excessive calcium intake
✔ Clinical Rationale & Source Grounding:
Limited income in older adults restricts food selection, making it difficult to achieve the necessary high nutrient density.
,GALEN COLLEGE OF NURSING — NSG 3100 EXAM 4 FINAL (FALL 2026)
Question 7. Which assessment finding in an infant receiving insufficient protein and total calories supports a
diagnosis of Marasmus rather than Kwashiorkor?
A) Normal body weight with dark red oral mucosal lesions
B) Pitting edema of the lower extremities and fluid retention
✔ C) Extremely prominent ribs and absent subcutaneous fat (Correct Answer)
D) A swollen abdomen with preserved subcutaneous fat
✔ Clinical Rationale & Source Grounding:
Marasmus causes severe wasting where ribs become very prominent and subcutaneous fat is not preserved.
Question 8. Why is Kwashiorkor characterized by fluid retention and edema despite low caloric intake?
✔ A) Severe protein deficiency reduces intravascular oncotic pressure, leading to fluid retention in
tissues. (Correct Answer)
B) High intake of fat-soluble vitamins DEKA triggers renal fluid conservation.
C) Excessive caloric intake causes hypernatremia and water retention.
D) Overproduction of collagen leads to vascular wall sclerosis.
✔ Clinical Rationale & Source Grounding:
Kwashiorkor is specifically caused by severe lack of protein accompanied by fluid retention.
Question 9. A nurse in a community clinic is conducting a nutritional screening. Which individual is at highest
risk for malnutrition related to distribution and access barriers?
A) An athlete consuming 3000 calories per day with high protein intake
✔ B) A low-income individual living in a food desert with an inadequate food budget (Correct Answer)
C) A post-menopausal female taking daily Calcium and Vitamin D supplements
D) A adult receiving continuous clear liquid diet for 12 hours post-surgery
✔ Clinical Rationale & Source Grounding:
Income and food distribution/access are major environmental determinants of malnutrition identified in the review.
Question 10. Which finding indicates Kwashiorkor in a toddler evaluated for failure to thrive?
A) Positive Trousseau sign with hyperactive reflexes
B) Prominent ribs with severe loss of subcutaneous fat
✔ C) Fluid retention with preserved subcutaneous fat layer (Correct Answer)
D) Kussmaul breathing with metabolic acidosis
✔ Clinical Rationale & Source Grounding:
Kwashiorkor manifests as protein deficiency with fluid retention while subcutaneous fat remains preserved.
Question 11. Which underlying cause leads to the development of Marasmus in infants?
A) Gastric suctioning resulting in hypochloremia
✔ B) Severe, prolonged deficit of both protein AND total calories (Correct Answer)
C) Excessive intake of hypertonic IV solutions
D) Isolated deficiency of Vitamin C leading to collagen failure
✔ Clinical Rationale & Source Grounding:
Marasmus is caused by a combined lack of protein AND calories.
, GALEN COLLEGE OF NURSING — NSG 3100 EXAM 4 FINAL (FALL 2026)
Question 12. When assessing an economically disadvantaged family's diet history, what key risk factor
should the nurse explore?
A) Overconsumption of monounsaturated fats from nuts and seeds
B) Excessive ingestion of fat-soluble vitamins DEKA
✔ C) Inadequate food budget and limited access to nutritious foods (Correct Answer)
D) Strict adherence to an 8-hour I&O measurement schedule
✔ Clinical Rationale & Source Grounding:
An inadequate food budget and restricted access directly impair nutrient intake.
Question 13. A nurse is reviewing pediatric malnutrition cases. Which presentation describes a child with
Kwashiorkor?
✔ A) The child's ribs are not prominent, but fluid retention and edema are evident. (Correct Answer)
B) The child has hyperchloremia from normal saline infusion.
C) The child's ribs are prominent, and all subcutaneous fat is absent.
D) The child has severe tetany from hypocalcemia.
✔ Clinical Rationale & Source Grounding:
In Kwashiorkor, ribs won't be prominent due to fluid retention and preserved subcutaneous fat.
Question 14. What metabolic outcome occurs when a patient experiences continuous nutrient intake
deficits?
A) Spontaneous shifting of fluid from intracellular to extracellular spaces.
B) Rapid elevation of serum troponin levels within 10 hours.
C) Immediate accumulation of toxic levels of water-soluble Vitamin C.
Question 15. An infant under 1 year old presents with severe physical alterations, prominent ribs, and lack of
subcutaneous fat. What is the nurse's priority assessment?
A) Assess for Warfarin toxicity and Vitamin K levels.
B) Assess for Kussmaul respirations caused by metabolic alkalosis.
C) Assess for signs of hypermagnesemia ('low and slow').
NSG 3100: Fundamental Concepts and Skills for Nursing Practice I
EXAM 4 FINAL FALL 2026
Question 1. A nurse is evaluating a 3-year-old child in a pediatric clinic. The child presents with generalized
edema, fluid retention, and a swollen abdomen, but has preserved subcutaneous fat and non -prominent ribs.
The parents report a diet consisting almost exclusively of low-protein carbohydrates. Which condition is
present?
A) Anorexia nervosa
B) Bulimia nervosa
C) Marasmus
Question 2. An infant under 1 year of age is admitted with severe emaciation, loss of subcutaneous fat, and
extremely prominent ribs. The infant's diet has lacked both adequate protein and overall calories. Which
nutritional alteration should the nurse document?
✔ A) Marasmus (Correct Answer)
B) Hyperphosphatemia
C) Metabolic acidosis
D) Kwashiorkor
✔ Clinical Rationale & Source Grounding:
Marasmus is characterized by a severe lack of both protein AND calories, most common in infants under 1 year old,
presenting with prominent ribs and loss of subcutaneous fat.
CONFIDENTIAL — GALEN 1 of 35 FALL 2026
,GALEN COLLEGE OF NURSING — NSG 3100 EXAM 4 FINAL (FALL 2026)
Question 3. Which key physical assessment feature differentiates Kwashiorkor from Marasmus in pediatric
patients?
✔ A) Preservation of subcutaneous fat and fluid retention in Kwashiorkor versus loss of
subcutaneous fat and prominent ribs in Marasmus. (Correct Answer)
B) Prominent ribs and severe wasting in Kwashiorkor versus generalized fluid retention in Marasmus.
C) Lack of calories only in Kwashiorkor versus lack of protein only in Marasmus.
D) Presence of tetany in Kwashiorkor versus positive Trousseau sign in Marasmus.
✔ Clinical Rationale & Source Grounding:
The course review explicitly notes that Kwashiorkor features fluid retention with preserved subcutaneous fat and
non-prominent ribs, whereas Marasmus features lack of protein AND calories with prominent ribs and absent
subcutaneous fat.
Question 4. When assessing social factors contributing to nutritional deficits in low-income families, which
primary barrier does the nurse identify?
A) Income leads to excessive accumulation of fat-soluble vitamins in liver tissue.
B) Income causes an involuntary elevation in basal metabolic rate.
✔ C) Income affects malnutrition due to lack of food distribution or access. (Correct Answer)
D) Income directly alters the absorption rate of water-soluble vitamins B and C.
✔ Clinical Rationale & Source Grounding:
The source material explicitly states under Chapter 30 that income can affect malnutrition because of a lack of
distribution or access.
Question 5. A nurse is performing a health history on a client living alone on a low fixed income. Which
dietary history risk factor places this client at heightened risk for malnutrition?
A) Regular consumption of monounsaturated fats and high-fiber foods
B) Daily weight monitoring causing rapid fluid volume expansion
C) Excessive daily intake of citrus fruits and white potatoes
Question 6. A nurse notes that a malnourished older adult living alone has a limited income. What is the
primary clinical consequence of this social risk factor?
A) Immediate breakdown of central venous catheter access sites
B) Development of hypermagnesemia secondary to dehydration
✔ C) Inability to purchase nutrient-dense foods required to meet essential body needs (Correct
Answer)
D) Hyperactive deep tendon reflexes caused by excessive calcium intake
✔ Clinical Rationale & Source Grounding:
Limited income in older adults restricts food selection, making it difficult to achieve the necessary high nutrient density.
,GALEN COLLEGE OF NURSING — NSG 3100 EXAM 4 FINAL (FALL 2026)
Question 7. Which assessment finding in an infant receiving insufficient protein and total calories supports a
diagnosis of Marasmus rather than Kwashiorkor?
A) Normal body weight with dark red oral mucosal lesions
B) Pitting edema of the lower extremities and fluid retention
✔ C) Extremely prominent ribs and absent subcutaneous fat (Correct Answer)
D) A swollen abdomen with preserved subcutaneous fat
✔ Clinical Rationale & Source Grounding:
Marasmus causes severe wasting where ribs become very prominent and subcutaneous fat is not preserved.
Question 8. Why is Kwashiorkor characterized by fluid retention and edema despite low caloric intake?
✔ A) Severe protein deficiency reduces intravascular oncotic pressure, leading to fluid retention in
tissues. (Correct Answer)
B) High intake of fat-soluble vitamins DEKA triggers renal fluid conservation.
C) Excessive caloric intake causes hypernatremia and water retention.
D) Overproduction of collagen leads to vascular wall sclerosis.
✔ Clinical Rationale & Source Grounding:
Kwashiorkor is specifically caused by severe lack of protein accompanied by fluid retention.
Question 9. A nurse in a community clinic is conducting a nutritional screening. Which individual is at highest
risk for malnutrition related to distribution and access barriers?
A) An athlete consuming 3000 calories per day with high protein intake
✔ B) A low-income individual living in a food desert with an inadequate food budget (Correct Answer)
C) A post-menopausal female taking daily Calcium and Vitamin D supplements
D) A adult receiving continuous clear liquid diet for 12 hours post-surgery
✔ Clinical Rationale & Source Grounding:
Income and food distribution/access are major environmental determinants of malnutrition identified in the review.
Question 10. Which finding indicates Kwashiorkor in a toddler evaluated for failure to thrive?
A) Positive Trousseau sign with hyperactive reflexes
B) Prominent ribs with severe loss of subcutaneous fat
✔ C) Fluid retention with preserved subcutaneous fat layer (Correct Answer)
D) Kussmaul breathing with metabolic acidosis
✔ Clinical Rationale & Source Grounding:
Kwashiorkor manifests as protein deficiency with fluid retention while subcutaneous fat remains preserved.
Question 11. Which underlying cause leads to the development of Marasmus in infants?
A) Gastric suctioning resulting in hypochloremia
✔ B) Severe, prolonged deficit of both protein AND total calories (Correct Answer)
C) Excessive intake of hypertonic IV solutions
D) Isolated deficiency of Vitamin C leading to collagen failure
✔ Clinical Rationale & Source Grounding:
Marasmus is caused by a combined lack of protein AND calories.
, GALEN COLLEGE OF NURSING — NSG 3100 EXAM 4 FINAL (FALL 2026)
Question 12. When assessing an economically disadvantaged family's diet history, what key risk factor
should the nurse explore?
A) Overconsumption of monounsaturated fats from nuts and seeds
B) Excessive ingestion of fat-soluble vitamins DEKA
✔ C) Inadequate food budget and limited access to nutritious foods (Correct Answer)
D) Strict adherence to an 8-hour I&O measurement schedule
✔ Clinical Rationale & Source Grounding:
An inadequate food budget and restricted access directly impair nutrient intake.
Question 13. A nurse is reviewing pediatric malnutrition cases. Which presentation describes a child with
Kwashiorkor?
✔ A) The child's ribs are not prominent, but fluid retention and edema are evident. (Correct Answer)
B) The child has hyperchloremia from normal saline infusion.
C) The child's ribs are prominent, and all subcutaneous fat is absent.
D) The child has severe tetany from hypocalcemia.
✔ Clinical Rationale & Source Grounding:
In Kwashiorkor, ribs won't be prominent due to fluid retention and preserved subcutaneous fat.
Question 14. What metabolic outcome occurs when a patient experiences continuous nutrient intake
deficits?
A) Spontaneous shifting of fluid from intracellular to extracellular spaces.
B) Rapid elevation of serum troponin levels within 10 hours.
C) Immediate accumulation of toxic levels of water-soluble Vitamin C.
Question 15. An infant under 1 year old presents with severe physical alterations, prominent ribs, and lack of
subcutaneous fat. What is the nurse's priority assessment?
A) Assess for Warfarin toxicity and Vitamin K levels.
B) Assess for Kussmaul respirations caused by metabolic alkalosis.
C) Assess for signs of hypermagnesemia ('low and slow').
