NR 228 Final Exam | Nutrition, Health & Wellness | Chamberlain University | Latest 2026/2027 145-Question Comprehensive Exam
NR228 / NR-228 Final Exam
Nutrition, Health & Wellness — Chamberlain University
Latest 2026/2027 Update — 100% Correct | Grade A
145 Questions • Multiple Choice • Comprehensive Final Coverage
Examination Overview: This 145-question comprehensive final exam is aligned with the 2026/2027 NR 228
Nutrition, Health & Wellness final exam blueprint at Chamberlain University. The exam integrates nutrition science
foundations with clinical nursing application across the lifespan and in therapeutic settings. Each question includes a
complete correct answer and a detailed rationale that doubles as study-guide content, providing nutrition physiology,
dietary standards, clinical application, and evidence-based nursing interventions. The cognitive distribution is
approximately 30% recall (nutrient functions, dietary standards, and definitions), 50% application (scenario-based
clinical decisions and diet selections), and 20% analysis (lab interpretation, deficiency identification, and concept
differentiation). Questions are distributed across eight content domains: Nutrition Foundations and Macronutrients;
Micronutrients, Water, and Electrolytes; Nutritional Assessment and Dietary Guidelines; Nutrition Across the Lifespan;
Therapeutic Diets and Medical Nutrition Therapy; Nutrition Support and Enteral/Parenteral Therapy; Malnutrition,
Obesity, and Eating Disorders; and Nutrition-Related Nursing Care, Education, and Cultural Considerations. Distractors
are deliberately constructed around the most common nutrition nursing pitfalls: recommending an incorrect therapeutic
diet, misidentifying deficiency manifestations, confusing fat-soluble with water-soluble vitamin toxicity, improper
enteral feeding administration, overlooking refeeding syndrome risk, misunderstanding cultural dietary restrictions, and
incorrect lab value interpretation. The 2026/2027 updates include current Dietary Guidelines for Americans
(2020-2025), MyPlate standards, ADA diabetes nutrition guidance, ASPEN nutrition support guidelines, and
evidence-based obesity and eating disorder management. Mastering both the correct answer and the reasoning behind
each distractor is the key to scoring at the Grade A / 100% Correct standard on the NR 228 Final Exam.
Section 1: Nutrition Foundations and Macronutrients (Digestion, Absorption,
Carbohydrates, Proteins, Lipids, & Energy Balance) — Q1–Q20
Q1: A nurse is teaching a client about nutrient absorption. Most chemical digestion and nutrient
absorption occurs in which part of the gastrointestinal tract?
A. Stomach
B. Small intestine (specifically the jejunum and ileum, where villi and microvilli maximize surface area
for absorption of carbohydrates, proteins, fats, vitamins, and minerals) [CORRECT]
C. Large intestine (colon)
D. Esophagus
Correct Answer: B
Rationale: The small intestine (duodenum, jejunum, ileum) is the primary site of chemical digestion and nutrient absorption.
The jejunum absorbs most carbohydrates and proteins, the ileum absorbs bile salts and vitamin B12 (with intrinsic factor),
and the duodenum receives pancreatic enzymes and bile for fat emulsification. The villi and microvilli dramatically increase
surface area (∼300 m²). The stomach (Option A) mechanically churns food and begins protein digestion with pepsin and HCl.
The large intestine (Option C) absorbs water and electrolytes and houses gut microbiota that produce vitamin K and some B
vitamins. The esophagus (Option D) transports food via peristalsis without digestion or absorption.
Page 1
,NR 228 Final Exam | Nutrition, Health & Wellness | Chamberlain University | Latest 2026/2027 145-Question Comprehensive Exam
Q2: Which hormone, released by the small intestine in response to acidic chyme, stimulates the pancreas
to release bicarbonate-rich secretions and the gallbladder to release bile?
A. Gastrin
B. Secretin (stimulates bicarbonate from pancreas); cholecystokinin (CCK) stimulates bile release from
gallbladder [CORRECT]
C. Insulin
D. Leptin
Correct Answer: B
Rationale: Secretin is released from the small intestine in response to acidic chyme entering from the stomach; it stimulates
the pancreas to release bicarbonate-rich fluid that neutralizes the acid. Cholecystokinin (CCK) is released in response to fats
and proteins in the duodenum; it stimulates gallbladder contraction (bile release for fat emulsification) and pancreatic enzyme
secretion. Gastrin (Option A) is released from the stomach and stimulates gastric acid secretion. Insulin (Option C) is from
pancreatic beta cells and lowers blood glucose. Leptin (Option D) is from adipose tissue and regulates satiety. These
hormones coordinate digestion and nutrient absorption.
Q3: A nurse is teaching a client about carbohydrate types. Which carbohydrate is a complex carbohydrate
that the body cannot digest but that promotes bowel regularity and helps lower cholesterol?
A. Sucrose
B. Dietary fiber (indigestible plant carbohydrate, either soluble which lowers cholesterol, or insoluble
which promotes bowel regularity) [CORRECT]
C. Lactose
D. Fructose
Correct Answer: B
Rationale: Dietary fiber is a complex carbohydrate (polysaccharide) that humans cannot digest due to lacking the enzyme
cellulase. Soluble fiber (oats, beans, apples, psyllium) dissolves in water, forms a gel, and lowers cholesterol by binding bile
acids; it also helps regulate blood glucose. Insoluble fiber (wheat bran, vegetables, whole grains) adds bulk to stool and
promotes regularity. Recommended intake: 25 g/day for women, 38 g/day for men (or 14 g/1000 kcal). Sucrose (Option A) is
table sugar (disaccharide of glucose + fructose). Lactose (Option C) is milk sugar (glucose + galactose). Fructose (Option D)
is a monosaccharide found in fruits and honey. Simple sugars provide calories but minimal satiety or health benefits
compared to fiber.
Page 2
,NR 228 Final Exam | Nutrition, Health & Wellness | Chamberlain University | Latest 2026/2027 145-Question Comprehensive Exam
Q4: Which food is the BEST source of complete protein (containing all nine essential amino acids in
adequate amounts)?
A. Black beans
B. Eggs (a complete, high biological value protein with all nine essential amino acids in ideal proportions)
[CORRECT]
C. White rice
D. Corn
Correct Answer: B
Rationale: Complete proteins (high biological value) contain all nine essential amino acids (histidine, isoleucine, leucine,
lysine, methionine, phenylalanine, threonine, tryptophan, valine) in adequate amounts. Animal sources (eggs, meat, poultry,
fish, dairy, soy) are complete proteins. Eggs are considered the reference protein with the highest biological value. Incomplete
proteins (low biological value) lack one or more essential amino acids; plant sources (beans, grains, nuts, seeds) are typically
incomplete. Complementary proteins (combining two incomplete proteins to provide all essential amino acids, e.g., beans and
rice) can meet protein needs. Black beans (Option A), white rice (Option C), and corn (Option D) are incomplete proteins.
Soy is the exception among plant proteins, being complete.
Q5: A nurse is reinforcing teaching about dietary fats. Which type of fat is associated with increased risk
of cardiovascular disease and should be limited in the diet?
A. Monounsaturated fats (olive oil, avocados, nuts)
B. Trans fats (partially hydrogenated oils, found in processed foods; they raise LDL and lower HDL,
significantly increasing cardiovascular risk) [CORRECT]
C. Polyunsaturated fats (corn oil, sunflower oil)
D. Omega-3 fatty acids (salmon, flaxseed, walnuts)
Correct Answer: B
Rationale: Trans fats are the most harmful dietary fats; they raise LDL (bad) cholesterol and lower HDL (good) cholesterol,
significantly increasing cardiovascular disease risk. The FDA banned artificial trans fats (partially hydrogenated oils) in 2018,
but small amounts may still be present in some processed foods. Avoid products listing “partially hydrogenated oils.”
Monounsaturated fats (Option A: olive oil, avocados, nuts) and polyunsaturated fats (Option C: corn, sunflower, soybean oils)
are heart-healthy fats that lower cardiovascular risk when replacing saturated and trans fats. Omega-3 fatty acids (Option D:
fatty fish, flaxseed, walnuts) have anti-inflammatory properties and reduce cardiovascular risk. Saturated fats (butter, red
meat, full-fat dairy) should also be limited (<10% of calories).
Page 3
, NR 228 Final Exam | Nutrition, Health & Wellness | Chamberlain University | Latest 2026/2027 145-Question Comprehensive Exam
Q6: Which two fatty acids are considered essential (must be obtained from the diet because the body
cannot synthesize them)?
A. Linoleic acid (omega-6) and alpha-linolenic acid (omega-3) [CORRECT]
B. Oleic acid and stearic acid
C. Palmitic acid and lauric acid
D. Arachidonic acid and EPA
Correct Answer: A
Rationale: Linoleic acid (an omega-6 fatty acid) and alpha-linolenic acid (ALA, an omega-3 fatty acid) are essential fatty
acids — the body cannot synthesize them, so they must be obtained from the diet. Linoleic acid sources: vegetable oils (corn,
safflower, soybean), nuts, seeds. ALA sources: flaxseed, walnuts, canola oil, soybean oil. The body can convert ALA to EPA
and DHA (longer-chain omega-3s), but conversion is inefficient; consuming fatty fish (salmon, sardines) provides direct EPA
and DHA. Omega-3s reduce inflammation, support brain and heart health, and are important in pregnancy for fetal brain
development. Omega-6s are pro-inflammatory in excess; the ideal ratio is debated. Options B, C, D list non-essential fatty
acids that the body can synthesize.
Q7: A 70-kg adult male requires approximately how many grams of protein per day to meet the
Recommended Dietary Allowance (RDA)?
A. 28 g/day (0.4 g/kg)
B. 56 g/day (0.8 g/kg body weight — the RDA for adults) [CORRECT]
C. 112 g/day (1.6 g/kg)
D. 175 g/day (2.5 g/kg)
Correct Answer: B
Rationale: The RDA for protein in adults is 0.8 g/kg body weight per day. For a 70-kg adult: 0.8 × 70 = 56 g/day. This is the
minimum to prevent deficiency in healthy, sedentary adults. Higher intakes may be beneficial for: older adults (1.0-1.2 g/kg
to prevent sarcopenia), athletes (1.2-2.0 g/kg), wound healing (1.25-1.5 g/kg), pregnancy and lactation (1.1 g/kg), and critical
illness (1.5-2.0 g/kg). Excessive protein (>2 g/kg in CKD) can stress kidneys. Option A (0.4 g/kg) is below the RDA and
would lead to negative nitrogen balance. Options C and D exceed typical needs and may be excessive for healthy adults.
Protein provides 4 kcal/g.
Q8: A nurse is calculating a client's caloric needs. Carbohydrates provide 4 kcal/g, proteins provide 4
kcal/g, and fats provide 9 kcal/g. Alcohol provides how many kcal/g?
A. 4 kcal/g
B. 7 kcal/g (alcohol provides calories but no nutritional value) [CORRECT]
C. 9 kcal/g
D. 0 kcal/g
Correct Answer: B
Rationale: Energy (calorie) content per gram: carbohydrates = 4 kcal/g, proteins = 4 kcal/g, fats = 9 kcal/g (most
energy-dense), alcohol = 7 kcal/g. Alcohol provides calories but no essential nutrients (empty calories). For example, one
standard drink (14 g alcohol) provides ∼98 kcal from alcohol alone, plus calories from mixers or carbohydrates in beer/wine.
Alcohol metabolism takes priority in the liver, potentially impairing nutrient metabolism. Excessive alcohol intake contributes
to weight gain, malnutrition (displaces nutrient-dense foods), liver disease, and vitamin deficiencies (especially B vitamins
like thiamine, folate). Option A (4 kcal/g) is carbohydrates and proteins. Option C (9 kcal/g) is fats. Option D is wrong;
alcohol does provide calories.
Page 4
NR228 / NR-228 Final Exam
Nutrition, Health & Wellness — Chamberlain University
Latest 2026/2027 Update — 100% Correct | Grade A
145 Questions • Multiple Choice • Comprehensive Final Coverage
Examination Overview: This 145-question comprehensive final exam is aligned with the 2026/2027 NR 228
Nutrition, Health & Wellness final exam blueprint at Chamberlain University. The exam integrates nutrition science
foundations with clinical nursing application across the lifespan and in therapeutic settings. Each question includes a
complete correct answer and a detailed rationale that doubles as study-guide content, providing nutrition physiology,
dietary standards, clinical application, and evidence-based nursing interventions. The cognitive distribution is
approximately 30% recall (nutrient functions, dietary standards, and definitions), 50% application (scenario-based
clinical decisions and diet selections), and 20% analysis (lab interpretation, deficiency identification, and concept
differentiation). Questions are distributed across eight content domains: Nutrition Foundations and Macronutrients;
Micronutrients, Water, and Electrolytes; Nutritional Assessment and Dietary Guidelines; Nutrition Across the Lifespan;
Therapeutic Diets and Medical Nutrition Therapy; Nutrition Support and Enteral/Parenteral Therapy; Malnutrition,
Obesity, and Eating Disorders; and Nutrition-Related Nursing Care, Education, and Cultural Considerations. Distractors
are deliberately constructed around the most common nutrition nursing pitfalls: recommending an incorrect therapeutic
diet, misidentifying deficiency manifestations, confusing fat-soluble with water-soluble vitamin toxicity, improper
enteral feeding administration, overlooking refeeding syndrome risk, misunderstanding cultural dietary restrictions, and
incorrect lab value interpretation. The 2026/2027 updates include current Dietary Guidelines for Americans
(2020-2025), MyPlate standards, ADA diabetes nutrition guidance, ASPEN nutrition support guidelines, and
evidence-based obesity and eating disorder management. Mastering both the correct answer and the reasoning behind
each distractor is the key to scoring at the Grade A / 100% Correct standard on the NR 228 Final Exam.
Section 1: Nutrition Foundations and Macronutrients (Digestion, Absorption,
Carbohydrates, Proteins, Lipids, & Energy Balance) — Q1–Q20
Q1: A nurse is teaching a client about nutrient absorption. Most chemical digestion and nutrient
absorption occurs in which part of the gastrointestinal tract?
A. Stomach
B. Small intestine (specifically the jejunum and ileum, where villi and microvilli maximize surface area
for absorption of carbohydrates, proteins, fats, vitamins, and minerals) [CORRECT]
C. Large intestine (colon)
D. Esophagus
Correct Answer: B
Rationale: The small intestine (duodenum, jejunum, ileum) is the primary site of chemical digestion and nutrient absorption.
The jejunum absorbs most carbohydrates and proteins, the ileum absorbs bile salts and vitamin B12 (with intrinsic factor),
and the duodenum receives pancreatic enzymes and bile for fat emulsification. The villi and microvilli dramatically increase
surface area (∼300 m²). The stomach (Option A) mechanically churns food and begins protein digestion with pepsin and HCl.
The large intestine (Option C) absorbs water and electrolytes and houses gut microbiota that produce vitamin K and some B
vitamins. The esophagus (Option D) transports food via peristalsis without digestion or absorption.
Page 1
,NR 228 Final Exam | Nutrition, Health & Wellness | Chamberlain University | Latest 2026/2027 145-Question Comprehensive Exam
Q2: Which hormone, released by the small intestine in response to acidic chyme, stimulates the pancreas
to release bicarbonate-rich secretions and the gallbladder to release bile?
A. Gastrin
B. Secretin (stimulates bicarbonate from pancreas); cholecystokinin (CCK) stimulates bile release from
gallbladder [CORRECT]
C. Insulin
D. Leptin
Correct Answer: B
Rationale: Secretin is released from the small intestine in response to acidic chyme entering from the stomach; it stimulates
the pancreas to release bicarbonate-rich fluid that neutralizes the acid. Cholecystokinin (CCK) is released in response to fats
and proteins in the duodenum; it stimulates gallbladder contraction (bile release for fat emulsification) and pancreatic enzyme
secretion. Gastrin (Option A) is released from the stomach and stimulates gastric acid secretion. Insulin (Option C) is from
pancreatic beta cells and lowers blood glucose. Leptin (Option D) is from adipose tissue and regulates satiety. These
hormones coordinate digestion and nutrient absorption.
Q3: A nurse is teaching a client about carbohydrate types. Which carbohydrate is a complex carbohydrate
that the body cannot digest but that promotes bowel regularity and helps lower cholesterol?
A. Sucrose
B. Dietary fiber (indigestible plant carbohydrate, either soluble which lowers cholesterol, or insoluble
which promotes bowel regularity) [CORRECT]
C. Lactose
D. Fructose
Correct Answer: B
Rationale: Dietary fiber is a complex carbohydrate (polysaccharide) that humans cannot digest due to lacking the enzyme
cellulase. Soluble fiber (oats, beans, apples, psyllium) dissolves in water, forms a gel, and lowers cholesterol by binding bile
acids; it also helps regulate blood glucose. Insoluble fiber (wheat bran, vegetables, whole grains) adds bulk to stool and
promotes regularity. Recommended intake: 25 g/day for women, 38 g/day for men (or 14 g/1000 kcal). Sucrose (Option A) is
table sugar (disaccharide of glucose + fructose). Lactose (Option C) is milk sugar (glucose + galactose). Fructose (Option D)
is a monosaccharide found in fruits and honey. Simple sugars provide calories but minimal satiety or health benefits
compared to fiber.
Page 2
,NR 228 Final Exam | Nutrition, Health & Wellness | Chamberlain University | Latest 2026/2027 145-Question Comprehensive Exam
Q4: Which food is the BEST source of complete protein (containing all nine essential amino acids in
adequate amounts)?
A. Black beans
B. Eggs (a complete, high biological value protein with all nine essential amino acids in ideal proportions)
[CORRECT]
C. White rice
D. Corn
Correct Answer: B
Rationale: Complete proteins (high biological value) contain all nine essential amino acids (histidine, isoleucine, leucine,
lysine, methionine, phenylalanine, threonine, tryptophan, valine) in adequate amounts. Animal sources (eggs, meat, poultry,
fish, dairy, soy) are complete proteins. Eggs are considered the reference protein with the highest biological value. Incomplete
proteins (low biological value) lack one or more essential amino acids; plant sources (beans, grains, nuts, seeds) are typically
incomplete. Complementary proteins (combining two incomplete proteins to provide all essential amino acids, e.g., beans and
rice) can meet protein needs. Black beans (Option A), white rice (Option C), and corn (Option D) are incomplete proteins.
Soy is the exception among plant proteins, being complete.
Q5: A nurse is reinforcing teaching about dietary fats. Which type of fat is associated with increased risk
of cardiovascular disease and should be limited in the diet?
A. Monounsaturated fats (olive oil, avocados, nuts)
B. Trans fats (partially hydrogenated oils, found in processed foods; they raise LDL and lower HDL,
significantly increasing cardiovascular risk) [CORRECT]
C. Polyunsaturated fats (corn oil, sunflower oil)
D. Omega-3 fatty acids (salmon, flaxseed, walnuts)
Correct Answer: B
Rationale: Trans fats are the most harmful dietary fats; they raise LDL (bad) cholesterol and lower HDL (good) cholesterol,
significantly increasing cardiovascular disease risk. The FDA banned artificial trans fats (partially hydrogenated oils) in 2018,
but small amounts may still be present in some processed foods. Avoid products listing “partially hydrogenated oils.”
Monounsaturated fats (Option A: olive oil, avocados, nuts) and polyunsaturated fats (Option C: corn, sunflower, soybean oils)
are heart-healthy fats that lower cardiovascular risk when replacing saturated and trans fats. Omega-3 fatty acids (Option D:
fatty fish, flaxseed, walnuts) have anti-inflammatory properties and reduce cardiovascular risk. Saturated fats (butter, red
meat, full-fat dairy) should also be limited (<10% of calories).
Page 3
, NR 228 Final Exam | Nutrition, Health & Wellness | Chamberlain University | Latest 2026/2027 145-Question Comprehensive Exam
Q6: Which two fatty acids are considered essential (must be obtained from the diet because the body
cannot synthesize them)?
A. Linoleic acid (omega-6) and alpha-linolenic acid (omega-3) [CORRECT]
B. Oleic acid and stearic acid
C. Palmitic acid and lauric acid
D. Arachidonic acid and EPA
Correct Answer: A
Rationale: Linoleic acid (an omega-6 fatty acid) and alpha-linolenic acid (ALA, an omega-3 fatty acid) are essential fatty
acids — the body cannot synthesize them, so they must be obtained from the diet. Linoleic acid sources: vegetable oils (corn,
safflower, soybean), nuts, seeds. ALA sources: flaxseed, walnuts, canola oil, soybean oil. The body can convert ALA to EPA
and DHA (longer-chain omega-3s), but conversion is inefficient; consuming fatty fish (salmon, sardines) provides direct EPA
and DHA. Omega-3s reduce inflammation, support brain and heart health, and are important in pregnancy for fetal brain
development. Omega-6s are pro-inflammatory in excess; the ideal ratio is debated. Options B, C, D list non-essential fatty
acids that the body can synthesize.
Q7: A 70-kg adult male requires approximately how many grams of protein per day to meet the
Recommended Dietary Allowance (RDA)?
A. 28 g/day (0.4 g/kg)
B. 56 g/day (0.8 g/kg body weight — the RDA for adults) [CORRECT]
C. 112 g/day (1.6 g/kg)
D. 175 g/day (2.5 g/kg)
Correct Answer: B
Rationale: The RDA for protein in adults is 0.8 g/kg body weight per day. For a 70-kg adult: 0.8 × 70 = 56 g/day. This is the
minimum to prevent deficiency in healthy, sedentary adults. Higher intakes may be beneficial for: older adults (1.0-1.2 g/kg
to prevent sarcopenia), athletes (1.2-2.0 g/kg), wound healing (1.25-1.5 g/kg), pregnancy and lactation (1.1 g/kg), and critical
illness (1.5-2.0 g/kg). Excessive protein (>2 g/kg in CKD) can stress kidneys. Option A (0.4 g/kg) is below the RDA and
would lead to negative nitrogen balance. Options C and D exceed typical needs and may be excessive for healthy adults.
Protein provides 4 kcal/g.
Q8: A nurse is calculating a client's caloric needs. Carbohydrates provide 4 kcal/g, proteins provide 4
kcal/g, and fats provide 9 kcal/g. Alcohol provides how many kcal/g?
A. 4 kcal/g
B. 7 kcal/g (alcohol provides calories but no nutritional value) [CORRECT]
C. 9 kcal/g
D. 0 kcal/g
Correct Answer: B
Rationale: Energy (calorie) content per gram: carbohydrates = 4 kcal/g, proteins = 4 kcal/g, fats = 9 kcal/g (most
energy-dense), alcohol = 7 kcal/g. Alcohol provides calories but no essential nutrients (empty calories). For example, one
standard drink (14 g alcohol) provides ∼98 kcal from alcohol alone, plus calories from mixers or carbohydrates in beer/wine.
Alcohol metabolism takes priority in the liver, potentially impairing nutrient metabolism. Excessive alcohol intake contributes
to weight gain, malnutrition (displaces nutrient-dense foods), liver disease, and vitamin deficiencies (especially B vitamins
like thiamine, folate). Option A (4 kcal/g) is carbohydrates and proteins. Option C (9 kcal/g) is fats. Option D is wrong;
alcohol does provide calories.
Page 4
