WGU D440 HESI Nutrition Exam ACTUAL EXAM
2026/2027 | Western Governors University Nutritional
Science Competency | Verified Q&A | Pass
Guaranteed - A+ Graded
Section 1: Foundations of Nutrition and Digestion (12 Questions)
Q1: A nurse is reviewing the digestive process with a patient who has recently undergone gastric bypass
surgery. The patient asks which enzyme is responsible for the initial chemical breakdown of
carbohydrates in the mouth. Which response by the nurse is most accurate?
A. Pepsin, which is secreted by chief cells and begins carbohydrate digestion in the stomach.
B. Salivary amylase (ptyalin), which hydrolyzes starch into maltose and dextrins in the oral cavity.
[CORRECT]
C. Pancreatic amylase, which is the primary enzyme for carbohydrate digestion and is secreted into the
duodenum.
D. Lactase, which breaks down lactose in the small intestine and is present in saliva.
Correct Answer: B
Rationale: Salivary amylase, secreted by the parotid and submandibular glands, initiates carbohydrate
digestion by hydrolyzing alpha-1,4 glycosidic bonds in starch to produce maltose and dextrins. The
Academy of Nutrition and Dietetics emphasizes understanding enzymatic digestion for patient education
on malabsorption disorders. Nurses must explain this process to patients with pancreatic insufficiency or
post-gastric surgery to clarify why carbohydrate digestion may be impaired.
Q2: A patient with Crohn's disease involving the terminal ileum is at risk for malabsorption of which
nutrient due to impaired enterohepatic circulation?
A. Vitamin C, which is absorbed throughout the small intestine via active transport.
B. Vitamin B12, which requires intrinsic factor and the ileum for absorption; bile acid reabsorption also
occurs in the terminal ileum, affecting fat-soluble vitamin absorption. [CORRECT]
C. Iron, which is primarily absorbed in the duodenum and proximal jejunum.
D. Calcium, which is absorbed in the duodenum via vitamin D-dependent active transport.
,Correct Answer: B
Rationale: The terminal ileum is the exclusive site for vitamin B12-intrinsic factor complex absorption
and the primary site for bile acid reabsorption; Crohn's disease involvement here causes B12 deficiency
and fat malabsorption due to disrupted enterohepatic circulation. The Academy of Nutrition and
Dietetics recommends B12 supplementation and monitoring for fat-soluble vitamin deficiencies in these
patients. Nurses must assess for megaloblastic anemia and steatorrhea in patients with terminal ileal
disease.
Q3: A nurse is caring for a patient with chronic pancreatitis. The patient asks why they are experiencing
steatorrhea and weight loss despite adequate dietary intake. Which explanation by the nurse is most
accurate?
A. The pancreas produces insufficient insulin, causing glucose malabsorption and osmotic diarrhea.
B. Pancreatic enzyme deficiency reduces the breakdown of triglycerides into fatty acids and
monoglycerides, causing fat malabsorption and caloric loss in stool. [CORRECT]
C. Bile duct obstruction prevents emulsification of fats, which is the primary cause of steatorrhea in
pancreatitis.
D. Gastric acid hypersecretion denatures pancreatic enzymes before they reach the small intestine.
Correct Answer: B
Rationale: Chronic pancreatitis destroys acinar cells, reducing pancreatic lipase secretion; without
adequate lipase, triglycerides cannot be hydrolyzed into absorbable fatty acids and monoglycerides,
resulting in steatorrhea and fat-soluble vitamin deficiencies. The Academy of Nutrition and Dietetics
recommends pancreatic enzyme replacement therapy with meals. Nurses must educate patients on
timing enzyme replacement with food intake and monitoring for fat-soluble vitamin deficiencies.
Q4: A patient is receiving enteral nutrition via a nasogastric tube. The nurse notes that the feeding is
infusing at 75 mL/hr continuously. The patient is prescribed 1,800 mL of formula over 24 hours. How
many hours will it take to complete the feeding, and what is the most appropriate nursing action?
A. 20 hours; increase the rate to 90 mL/hr to complete the feeding within 24 hours.
B. 24 hours; the current rate of 75 mL/hr is correct for 1,800 mL over 24 hours (1,800 ÷ 75 = 24).
[CORRECT]
C. 22 hours; decrease the rate to 68 mL/hr to prevent gastric residual accumulation.
D. 18 hours; the feeding should be completed faster to allow a 6-hour rest period for gastric emptying.
Correct Answer: B
Rationale: At 75 mL/hr, 1,800 mL of enteral formula will infuse over exactly 24 hours (1,800 ÷ 75 = 24),
which is the standard calculation for continuous feeding rates. ASPEN guidelines recommend
maintaining prescribed rates to meet nutritional goals while monitoring gastric tolerance. Nurses must
,verify feeding calculations, assess gastric residuals per protocol, and avoid arbitrary rate changes that
compromise nutritional adequacy.
Q5: A patient with liver cirrhosis and portal hypertension develops hepatic encephalopathy. The nurse
understands that the elevated blood ammonia level is primarily derived from which metabolic process?
A. Incomplete beta-oxidation of fatty acids in the failing liver.
B. Bacterial breakdown of protein and amino acids in the colon, producing ammonia that is normally
detoxified by the liver but accumulates with impaired hepatic function. [CORRECT]
C. Excessive urea synthesis from amino acid catabolism in the kidneys.
D. Lactate accumulation from anaerobic metabolism in hypoperfused tissues.
Correct Answer: B
Rationale: Hepatic encephalopathy results from impaired hepatic detoxification of ammonia, which is
primarily generated by colonic bacteria through protein and amino acid deamination; cirrhosis with
portosystemic shunting allows ammonia to bypass hepatic metabolism. The Academy of Nutrition and
Dietetics recommends protein restriction (0.8–1.0 g/kg) with branched-chain amino acid
supplementation. Nurses must monitor ammonia levels, assess mental status changes, and ensure
adequate but not excessive protein intake.
Q6: A nurse is teaching a patient about the role of dietary fiber in maintaining gastrointestinal health.
Which statement by the patient indicates correct understanding?
A. "Soluble fiber adds bulk to stool and speeds transit time through the colon."
B. "Insoluble fiber forms a gel in the digestive tract and helps lower my cholesterol."
C. "Soluble fiber dissolves in water, forms viscous gels, and can help lower LDL cholesterol by binding
bile acids in the intestine." [CORRECT]
D. "All types of fiber are completely digested and absorbed as energy sources."
Correct Answer: C
Rationale: Soluble fiber (e.g., oats, beans, apples) dissolves in water to form viscous gels that bind bile
acids and cholesterol in the intestine, promoting their excretion and reducing LDL cholesterol; insoluble
fiber (e.g., wheat bran) adds bulk and speeds transit. The USDA Dietary Guidelines recommend 14 g
fiber per 1,000 kcal. Nurses must differentiate fiber types to guide patients with hyperlipidemia,
constipation, or diabetes toward appropriate food sources.
Q7: A patient with short bowel syndrome (SBS) following extensive small bowel resection is at highest
risk for which nutritional complication?
, A. Hypermagnesemia due to increased colonic absorption.
B. Dehydration, electrolyte imbalances, and malabsorption of macronutrients and micronutrients due to
reduced absorptive surface area and rapid transit. [CORRECT]
C. Constipation due to decreased intestinal motility from surgical denervation.
D. Hypervitaminosis A from excessive absorption of fat-soluble vitamins.
Correct Answer: B
Rationale: Short bowel syndrome reduces intestinal absorptive surface area and accelerates transit,
causing profound fluid, electrolyte, and nutrient malabsorption; the severity depends on the length and
site of resection (jejunal vs. ileal). ASPEN guidelines recommend parenteral nutrition support, oral
rehydration solutions, and gradual enteral adaptation. Nurses must monitor intake/output, electrolytes,
and nutritional status while supporting the transition from parenteral to enteral nutrition.
Q8: A nurse is calculating the fluid requirements for a 70-year-old patient weighing 70 kg using the
standard adult formula. Which calculation is most accurate?
A. 1,500 mL/day (30 mL/kg for first 10 kg, 20 mL/kg for next 10 kg, 15 mL/kg for remaining 50 kg).
B. 2,100 mL/day (30 mL/kg × 70 kg = 2,100 mL). [CORRECT]
C. 3,500 mL/day (50 mL/kg × 70 kg = 3,500 mL).
D. 1,400 mL/day (20 mL/kg × 70 kg = 1,400 mL).
Correct Answer: B
Rationale: Standard adult fluid maintenance is approximately 30 mL/kg/day (or 1,500 mL for first 20 kg
plus 20 mL/kg for remaining weight); for a 70 kg adult, 30 mL/kg yields 2,100 mL daily. The Academy of
Nutrition and Dietetics notes that older adults may require adjusted calculations due to decreased thirst
sensation. Nurses must calculate fluid needs accurately, adjust for clinical conditions (fever, diarrhea,
cardiac/renal disease), and monitor hydration status.
Q9: A patient with gastroesophageal reflux disease (GERD) asks the nurse which dietary modifications
will help reduce symptoms. Which recommendation is most appropriate?
A. "Drink a large glass of water with each meal to dilute stomach acid."
B. "Avoid eating within 3 hours of bedtime, eat smaller meals, and limit high-fat foods, caffeine,
chocolate, and peppermint." [CORRECT]
C. "Increase citrus fruit intake to neutralize stomach acid with natural alkalinity."
D. "Lie down immediately after eating to promote gastric emptying by gravity."
Correct Answer: B
Rationale: GERD management includes avoiding large meals, late eating, and foods that reduce lower
esophageal sphincter tone (high-fat, caffeine, chocolate, peppermint, alcohol) while maintaining head-
of-bed elevation. The Academy of Nutrition and Dietetics and ACG guidelines support these lifestyle
2026/2027 | Western Governors University Nutritional
Science Competency | Verified Q&A | Pass
Guaranteed - A+ Graded
Section 1: Foundations of Nutrition and Digestion (12 Questions)
Q1: A nurse is reviewing the digestive process with a patient who has recently undergone gastric bypass
surgery. The patient asks which enzyme is responsible for the initial chemical breakdown of
carbohydrates in the mouth. Which response by the nurse is most accurate?
A. Pepsin, which is secreted by chief cells and begins carbohydrate digestion in the stomach.
B. Salivary amylase (ptyalin), which hydrolyzes starch into maltose and dextrins in the oral cavity.
[CORRECT]
C. Pancreatic amylase, which is the primary enzyme for carbohydrate digestion and is secreted into the
duodenum.
D. Lactase, which breaks down lactose in the small intestine and is present in saliva.
Correct Answer: B
Rationale: Salivary amylase, secreted by the parotid and submandibular glands, initiates carbohydrate
digestion by hydrolyzing alpha-1,4 glycosidic bonds in starch to produce maltose and dextrins. The
Academy of Nutrition and Dietetics emphasizes understanding enzymatic digestion for patient education
on malabsorption disorders. Nurses must explain this process to patients with pancreatic insufficiency or
post-gastric surgery to clarify why carbohydrate digestion may be impaired.
Q2: A patient with Crohn's disease involving the terminal ileum is at risk for malabsorption of which
nutrient due to impaired enterohepatic circulation?
A. Vitamin C, which is absorbed throughout the small intestine via active transport.
B. Vitamin B12, which requires intrinsic factor and the ileum for absorption; bile acid reabsorption also
occurs in the terminal ileum, affecting fat-soluble vitamin absorption. [CORRECT]
C. Iron, which is primarily absorbed in the duodenum and proximal jejunum.
D. Calcium, which is absorbed in the duodenum via vitamin D-dependent active transport.
,Correct Answer: B
Rationale: The terminal ileum is the exclusive site for vitamin B12-intrinsic factor complex absorption
and the primary site for bile acid reabsorption; Crohn's disease involvement here causes B12 deficiency
and fat malabsorption due to disrupted enterohepatic circulation. The Academy of Nutrition and
Dietetics recommends B12 supplementation and monitoring for fat-soluble vitamin deficiencies in these
patients. Nurses must assess for megaloblastic anemia and steatorrhea in patients with terminal ileal
disease.
Q3: A nurse is caring for a patient with chronic pancreatitis. The patient asks why they are experiencing
steatorrhea and weight loss despite adequate dietary intake. Which explanation by the nurse is most
accurate?
A. The pancreas produces insufficient insulin, causing glucose malabsorption and osmotic diarrhea.
B. Pancreatic enzyme deficiency reduces the breakdown of triglycerides into fatty acids and
monoglycerides, causing fat malabsorption and caloric loss in stool. [CORRECT]
C. Bile duct obstruction prevents emulsification of fats, which is the primary cause of steatorrhea in
pancreatitis.
D. Gastric acid hypersecretion denatures pancreatic enzymes before they reach the small intestine.
Correct Answer: B
Rationale: Chronic pancreatitis destroys acinar cells, reducing pancreatic lipase secretion; without
adequate lipase, triglycerides cannot be hydrolyzed into absorbable fatty acids and monoglycerides,
resulting in steatorrhea and fat-soluble vitamin deficiencies. The Academy of Nutrition and Dietetics
recommends pancreatic enzyme replacement therapy with meals. Nurses must educate patients on
timing enzyme replacement with food intake and monitoring for fat-soluble vitamin deficiencies.
Q4: A patient is receiving enteral nutrition via a nasogastric tube. The nurse notes that the feeding is
infusing at 75 mL/hr continuously. The patient is prescribed 1,800 mL of formula over 24 hours. How
many hours will it take to complete the feeding, and what is the most appropriate nursing action?
A. 20 hours; increase the rate to 90 mL/hr to complete the feeding within 24 hours.
B. 24 hours; the current rate of 75 mL/hr is correct for 1,800 mL over 24 hours (1,800 ÷ 75 = 24).
[CORRECT]
C. 22 hours; decrease the rate to 68 mL/hr to prevent gastric residual accumulation.
D. 18 hours; the feeding should be completed faster to allow a 6-hour rest period for gastric emptying.
Correct Answer: B
Rationale: At 75 mL/hr, 1,800 mL of enteral formula will infuse over exactly 24 hours (1,800 ÷ 75 = 24),
which is the standard calculation for continuous feeding rates. ASPEN guidelines recommend
maintaining prescribed rates to meet nutritional goals while monitoring gastric tolerance. Nurses must
,verify feeding calculations, assess gastric residuals per protocol, and avoid arbitrary rate changes that
compromise nutritional adequacy.
Q5: A patient with liver cirrhosis and portal hypertension develops hepatic encephalopathy. The nurse
understands that the elevated blood ammonia level is primarily derived from which metabolic process?
A. Incomplete beta-oxidation of fatty acids in the failing liver.
B. Bacterial breakdown of protein and amino acids in the colon, producing ammonia that is normally
detoxified by the liver but accumulates with impaired hepatic function. [CORRECT]
C. Excessive urea synthesis from amino acid catabolism in the kidneys.
D. Lactate accumulation from anaerobic metabolism in hypoperfused tissues.
Correct Answer: B
Rationale: Hepatic encephalopathy results from impaired hepatic detoxification of ammonia, which is
primarily generated by colonic bacteria through protein and amino acid deamination; cirrhosis with
portosystemic shunting allows ammonia to bypass hepatic metabolism. The Academy of Nutrition and
Dietetics recommends protein restriction (0.8–1.0 g/kg) with branched-chain amino acid
supplementation. Nurses must monitor ammonia levels, assess mental status changes, and ensure
adequate but not excessive protein intake.
Q6: A nurse is teaching a patient about the role of dietary fiber in maintaining gastrointestinal health.
Which statement by the patient indicates correct understanding?
A. "Soluble fiber adds bulk to stool and speeds transit time through the colon."
B. "Insoluble fiber forms a gel in the digestive tract and helps lower my cholesterol."
C. "Soluble fiber dissolves in water, forms viscous gels, and can help lower LDL cholesterol by binding
bile acids in the intestine." [CORRECT]
D. "All types of fiber are completely digested and absorbed as energy sources."
Correct Answer: C
Rationale: Soluble fiber (e.g., oats, beans, apples) dissolves in water to form viscous gels that bind bile
acids and cholesterol in the intestine, promoting their excretion and reducing LDL cholesterol; insoluble
fiber (e.g., wheat bran) adds bulk and speeds transit. The USDA Dietary Guidelines recommend 14 g
fiber per 1,000 kcal. Nurses must differentiate fiber types to guide patients with hyperlipidemia,
constipation, or diabetes toward appropriate food sources.
Q7: A patient with short bowel syndrome (SBS) following extensive small bowel resection is at highest
risk for which nutritional complication?
, A. Hypermagnesemia due to increased colonic absorption.
B. Dehydration, electrolyte imbalances, and malabsorption of macronutrients and micronutrients due to
reduced absorptive surface area and rapid transit. [CORRECT]
C. Constipation due to decreased intestinal motility from surgical denervation.
D. Hypervitaminosis A from excessive absorption of fat-soluble vitamins.
Correct Answer: B
Rationale: Short bowel syndrome reduces intestinal absorptive surface area and accelerates transit,
causing profound fluid, electrolyte, and nutrient malabsorption; the severity depends on the length and
site of resection (jejunal vs. ileal). ASPEN guidelines recommend parenteral nutrition support, oral
rehydration solutions, and gradual enteral adaptation. Nurses must monitor intake/output, electrolytes,
and nutritional status while supporting the transition from parenteral to enteral nutrition.
Q8: A nurse is calculating the fluid requirements for a 70-year-old patient weighing 70 kg using the
standard adult formula. Which calculation is most accurate?
A. 1,500 mL/day (30 mL/kg for first 10 kg, 20 mL/kg for next 10 kg, 15 mL/kg for remaining 50 kg).
B. 2,100 mL/day (30 mL/kg × 70 kg = 2,100 mL). [CORRECT]
C. 3,500 mL/day (50 mL/kg × 70 kg = 3,500 mL).
D. 1,400 mL/day (20 mL/kg × 70 kg = 1,400 mL).
Correct Answer: B
Rationale: Standard adult fluid maintenance is approximately 30 mL/kg/day (or 1,500 mL for first 20 kg
plus 20 mL/kg for remaining weight); for a 70 kg adult, 30 mL/kg yields 2,100 mL daily. The Academy of
Nutrition and Dietetics notes that older adults may require adjusted calculations due to decreased thirst
sensation. Nurses must calculate fluid needs accurately, adjust for clinical conditions (fever, diarrhea,
cardiac/renal disease), and monitor hydration status.
Q9: A patient with gastroesophageal reflux disease (GERD) asks the nurse which dietary modifications
will help reduce symptoms. Which recommendation is most appropriate?
A. "Drink a large glass of water with each meal to dilute stomach acid."
B. "Avoid eating within 3 hours of bedtime, eat smaller meals, and limit high-fat foods, caffeine,
chocolate, and peppermint." [CORRECT]
C. "Increase citrus fruit intake to neutralize stomach acid with natural alkalinity."
D. "Lie down immediately after eating to promote gastric emptying by gravity."
Correct Answer: B
Rationale: GERD management includes avoiding large meals, late eating, and foods that reduce lower
esophageal sphincter tone (high-fat, caffeine, chocolate, peppermint, alcohol) while maintaining head-
of-bed elevation. The Academy of Nutrition and Dietetics and ACG guidelines support these lifestyle
