ATI RN Nutrition Proctored Exam QUESTIONS
AND ANSWERS WITH RATIONALES/ GRADED
A+/2026 UPDATE /100%CORRECT
Part 1: NGN Case Study (Matrix/Cloze) – Wound Healing & Malnutrition
Client: Mrs. Dawson, 78 y/o, Stage 3 sacral pressure injury.
Labs: Albumin 2.4 g/dL (Low), Pre-albumin 9 mg/dL (Low), Hgb 9.2 g/dL.
History: Unintentional weight loss of 10% in 1 month.
Question 1 (Matrix/SATA): Based on the clinical findings, which actions should the nurse initiate?
(Select all that apply)
A. Consult a dietitian for a high-protein, high-calorie meal plan.
B. Encourage fluid restriction to prevent electrolyte imbalance.
C. Provide zinc and Vitamin C supplements as prescribed.
D. Offer large meals three times a day to increase intake.
E. Monitor I&O and daily weight.
Answer & Rationale:
• A. Correct: High protein (1.25-1.5 g/kg) is essential for tissue repair; high calories prevent
catabolism.
• B. Incorrect: Fluid restriction is for renal or heart failure; hydration is needed for perfusion to
the wound site.
• C. Correct: Vitamin C is essential for collagen synthesis; Zinc is a cofactor for enzymes in wound
healing.
• D. Incorrect: Clients with anorexia experience early satiety; small, frequent meals are better
tolerated.
• E. Correct: Daily weights are the best indicator of fluid and nutritional status trends.
Question 2 (Cloze/ Drop Down): The dietitian orders a high-protein diet. If Mrs. Dawson weighs 60 kg
(132 lbs) and the recommended protein intake for a Stage 3 ulcer is 1.5 g/kg/day, the client should
consume [Select Answer] grams of protein per day.
• Options: (A) 60, (B) 75, (C) 90, (D) 120
• Answer: C. 90
, • Rationale: 60 kg × 1.5 g = 90 grams.
Part 2: Medical-Surgical Nutrition
Question 3: A nurse is teaching a client with Celiac Disease about dietary choices. Which breakfast
selection by the client indicates understanding of the teaching?
A. Wheat toast with butter and grape jelly.
B. Oatmeal made with skim milk and bananas.
C. Scrambled eggs with turkey sausage and orange juice.
D. Rye bagel with cream cheese and strawberries.
Answer: C. Scrambled eggs with turkey sausage and orange juice.
• Rationale: Celiac disease requires strict avoidance of gluten (wheat, barley, rye). Eggs, meat, and
juice are naturally gluten-free. Note: Oats are often cross-contaminated unless certified gluten-
free.
Question 4: A client with Heart Failure is placed on a 2-gram sodium diet. Which meal selection would
require the nurse to provide further teaching?
A. Baked cod with lemon pepper, steamed broccoli, and a baked potato.
B. Grilled chicken breast, white rice, and fresh green beans.
C. Ham sandwich on whole wheat bread with a side of pickles.
D. Lean steak, whole wheat pasta, and a side salad with oil/vinegar.
Answer: C. Ham sandwich with pickles.
• Rationale: Ham and pickles are processed/cured foods extremely high in sodium. Fresh meats
and vegetables are naturally low in sodium.
Question 5: A nurse is administering Ferrous Sulfate (Iron) to a client with anemia. Which instruction
should the nurse include for optimal absorption?
A. "Take the medication with a glass of milk to coat the stomach."
B. "Take the medication with a glass of orange juice."
C. "Crush the enteric-coated tablet for faster release."
D. "Take the medication with an antacid to prevent nausea."
Answer: B. "Take with orange juice."
• Rationale: Vitamin C (ascorbic acid) enhances iron absorption. Dairy/antacids (calcium) inhibit
absorption.
Question 6: A client with Chronic Kidney Disease (CKD) has a potassium level of 6.2 mEq/L (Normal: 3.5-
5.0). Which food should the nurse remove from the breakfast tray?
A. Scrambled eggs.
B. White toast with butter.
C. Banana slices.
D. Applesauce.
, Answer: C. Banana slices.
• Rationale: Bananas are extremely high in potassium. Hyperkalemia (6.2) is a medical emergency
that can cause cardiac dysrhythmias.
Question 7 (SATA): A client is starting Warfarin (Coumadin) therapy. Which statements about diet
education are correct? (Select all that apply)
A. "You should avoid eating leafy green vegetables entirely."
B. "It is important to maintain a consistent intake of Vitamin K-rich foods."
C. "Cranberry juice may increase the effects of your medication."
D. "You may take St. John's Wort to help with mood swings."
E. "Green tea is a safe substitute for coffee."
Answer: B & C.
• Rationale: Warfarin works by inhibiting Vitamin K. Consistency is key (B). Cranberry juice is
known to potentiate (increase) Warfarin's effects, leading to bleeding risk (C). St. John's Wort
decreases Warfarin efficacy.
Part 3: Enteral & Parenteral Nutrition (TPN)
Question 8: A client receiving continuous tube feeding has a gastric residual volume (GRV) of 350 mL.
What is the nurse's priority action?
A. Discard the residual and increase the rate by 10 mL/hr.
B. Hold the feeding and reassess in 1 hour.
C. Flush the tube with 50 mL of warm water.
D. Change the tubing immediately.
Answer: B. Hold the feeding and reassess in 1 hour.
• Rationale: High residuals (>250-500 mL) indicate gastric intolerance and risk for aspiration. The
feeding should be held, and the abdomen assessed.
Question 9 (NGN Bow-tie): A client is receiving TPN (Total Parenteral Nutrition) via a PICC line. The
nurse notes the blood glucose is 320 mg/dL. Before notifying the provider, the nurse should anticipate
an order for which of the following?
A. Discontinuation of the TPN.
B. Insulin (sliding scale or added to the TPN bag).
C. Increasing the TPN rate to dilute the glucose.
D. Administration of glucagon.
Answer: B. Insulin.
• Rationale: The high dextrose concentration in TPN frequently causes hyperglycemia. Insulin
(subcutaneous or in the bag) is the standard treatment. Never stop TPN abruptly (risk of
rebound hypoglycemia).
AND ANSWERS WITH RATIONALES/ GRADED
A+/2026 UPDATE /100%CORRECT
Part 1: NGN Case Study (Matrix/Cloze) – Wound Healing & Malnutrition
Client: Mrs. Dawson, 78 y/o, Stage 3 sacral pressure injury.
Labs: Albumin 2.4 g/dL (Low), Pre-albumin 9 mg/dL (Low), Hgb 9.2 g/dL.
History: Unintentional weight loss of 10% in 1 month.
Question 1 (Matrix/SATA): Based on the clinical findings, which actions should the nurse initiate?
(Select all that apply)
A. Consult a dietitian for a high-protein, high-calorie meal plan.
B. Encourage fluid restriction to prevent electrolyte imbalance.
C. Provide zinc and Vitamin C supplements as prescribed.
D. Offer large meals three times a day to increase intake.
E. Monitor I&O and daily weight.
Answer & Rationale:
• A. Correct: High protein (1.25-1.5 g/kg) is essential for tissue repair; high calories prevent
catabolism.
• B. Incorrect: Fluid restriction is for renal or heart failure; hydration is needed for perfusion to
the wound site.
• C. Correct: Vitamin C is essential for collagen synthesis; Zinc is a cofactor for enzymes in wound
healing.
• D. Incorrect: Clients with anorexia experience early satiety; small, frequent meals are better
tolerated.
• E. Correct: Daily weights are the best indicator of fluid and nutritional status trends.
Question 2 (Cloze/ Drop Down): The dietitian orders a high-protein diet. If Mrs. Dawson weighs 60 kg
(132 lbs) and the recommended protein intake for a Stage 3 ulcer is 1.5 g/kg/day, the client should
consume [Select Answer] grams of protein per day.
• Options: (A) 60, (B) 75, (C) 90, (D) 120
• Answer: C. 90
, • Rationale: 60 kg × 1.5 g = 90 grams.
Part 2: Medical-Surgical Nutrition
Question 3: A nurse is teaching a client with Celiac Disease about dietary choices. Which breakfast
selection by the client indicates understanding of the teaching?
A. Wheat toast with butter and grape jelly.
B. Oatmeal made with skim milk and bananas.
C. Scrambled eggs with turkey sausage and orange juice.
D. Rye bagel with cream cheese and strawberries.
Answer: C. Scrambled eggs with turkey sausage and orange juice.
• Rationale: Celiac disease requires strict avoidance of gluten (wheat, barley, rye). Eggs, meat, and
juice are naturally gluten-free. Note: Oats are often cross-contaminated unless certified gluten-
free.
Question 4: A client with Heart Failure is placed on a 2-gram sodium diet. Which meal selection would
require the nurse to provide further teaching?
A. Baked cod with lemon pepper, steamed broccoli, and a baked potato.
B. Grilled chicken breast, white rice, and fresh green beans.
C. Ham sandwich on whole wheat bread with a side of pickles.
D. Lean steak, whole wheat pasta, and a side salad with oil/vinegar.
Answer: C. Ham sandwich with pickles.
• Rationale: Ham and pickles are processed/cured foods extremely high in sodium. Fresh meats
and vegetables are naturally low in sodium.
Question 5: A nurse is administering Ferrous Sulfate (Iron) to a client with anemia. Which instruction
should the nurse include for optimal absorption?
A. "Take the medication with a glass of milk to coat the stomach."
B. "Take the medication with a glass of orange juice."
C. "Crush the enteric-coated tablet for faster release."
D. "Take the medication with an antacid to prevent nausea."
Answer: B. "Take with orange juice."
• Rationale: Vitamin C (ascorbic acid) enhances iron absorption. Dairy/antacids (calcium) inhibit
absorption.
Question 6: A client with Chronic Kidney Disease (CKD) has a potassium level of 6.2 mEq/L (Normal: 3.5-
5.0). Which food should the nurse remove from the breakfast tray?
A. Scrambled eggs.
B. White toast with butter.
C. Banana slices.
D. Applesauce.
, Answer: C. Banana slices.
• Rationale: Bananas are extremely high in potassium. Hyperkalemia (6.2) is a medical emergency
that can cause cardiac dysrhythmias.
Question 7 (SATA): A client is starting Warfarin (Coumadin) therapy. Which statements about diet
education are correct? (Select all that apply)
A. "You should avoid eating leafy green vegetables entirely."
B. "It is important to maintain a consistent intake of Vitamin K-rich foods."
C. "Cranberry juice may increase the effects of your medication."
D. "You may take St. John's Wort to help with mood swings."
E. "Green tea is a safe substitute for coffee."
Answer: B & C.
• Rationale: Warfarin works by inhibiting Vitamin K. Consistency is key (B). Cranberry juice is
known to potentiate (increase) Warfarin's effects, leading to bleeding risk (C). St. John's Wort
decreases Warfarin efficacy.
Part 3: Enteral & Parenteral Nutrition (TPN)
Question 8: A client receiving continuous tube feeding has a gastric residual volume (GRV) of 350 mL.
What is the nurse's priority action?
A. Discard the residual and increase the rate by 10 mL/hr.
B. Hold the feeding and reassess in 1 hour.
C. Flush the tube with 50 mL of warm water.
D. Change the tubing immediately.
Answer: B. Hold the feeding and reassess in 1 hour.
• Rationale: High residuals (>250-500 mL) indicate gastric intolerance and risk for aspiration. The
feeding should be held, and the abdomen assessed.
Question 9 (NGN Bow-tie): A client is receiving TPN (Total Parenteral Nutrition) via a PICC line. The
nurse notes the blood glucose is 320 mg/dL. Before notifying the provider, the nurse should anticipate
an order for which of the following?
A. Discontinuation of the TPN.
B. Insulin (sliding scale or added to the TPN bag).
C. Increasing the TPN rate to dilute the glucose.
D. Administration of glucagon.
Answer: B. Insulin.
• Rationale: The high dextrose concentration in TPN frequently causes hyperglycemia. Insulin
(subcutaneous or in the bag) is the standard treatment. Never stop TPN abruptly (risk of
rebound hypoglycemia).
