Nursing Acceleration Challenge Exam I PN Nutrition and Diet Therapy — Questions and Answers
Question 1: A nurse is caring for a patient with chronic kidney disease (CKD). Which dietary modification is most appropriate for this patient?
- High-protein, high-potassium diet
- Low-protein, low-potassium, low-phosphorus diet (Correct answer)
- High-carbohydrate, high-sodium diet
- Low-fat, high-fiber diet with unlimited fluid intake
Correct answer: Low-protein, low-potassium, low-phosphorus diet
CKD patients require restricted protein to reduce nitrogenous waste, restricted potassium to prevent hyperkalemia, and restricted phosphorus to prevent renal osteodystrophy. Sodium and fluid are also typically restricted.
Question 2: A nurse is preparing to administer a tube feeding via nasogastric (NG) tube. Which action should be performed FIRST?
- Flush the tube with 30 mL of water
- Verify tube placement by checking gastric pH and auscultating the abdomen (Correct answer)
- Elevate the head of the bed to 30–45 degrees
- Connect the feeding bag and set the pump rate
Correct answer: Verify tube placement by checking gastric pH and auscultating the abdomen
Verifying tube placement is the priority safety step before initiating any tube feeding to prevent aspiration. pH of gastric aspirate should be ≤5.5. This must happen before positioning or starting the feed.
Question 3: Which laboratory value best reflects a patient's long-term nutritional status and protein stores?
- Serum albumin (Correct answer)
- Blood glucose
- Hemoglobin A1c
- Total cholesterol
Correct answer: Serum albumin
Serum albumin reflects protein stores over approximately 20 days and is used as a marker of chronic nutritional status. Low albumin indicates protein-calorie malnutrition. Prealbumin reflects shorter-term status, but albumin remains the classic long-term marker.
Question 4: A patient with dumping syndrome following gastrectomy should be taught to:
- Drink large amounts of fluid with meals to aid digestion
- Eat small, frequent meals low in simple sugars and lie down after eating (Correct answer)
- Increase dietary fiber and eat three large meals per day
- Consume a high-carbohydrate diet with moderate fluid intake during meals
Correct answer: Eat small, frequent meals low in simple sugars and lie down after eating
Dumping syndrome occurs when hyperosmolar food rapidly enters the small intestine. Management includes small frequent meals, avoiding simple sugars (which draw fluid into the gut), limiting fluids during meals, and lying down 30 minutes after eating to slow gastric emptying.
Question 5: A nurse is counseling a patient on a low-sodium diet. Which food choice indicates the patient needs further teaching?
- Fresh baked chicken breast
- Canned vegetable soup (Correct answer)
- Fresh steamed broccoli
- An apple
Correct answer: Canned vegetable soup
Canned soups are extremely high in sodium (often 800–1,200 mg per serving) and are a major source of hidden sodium. Fresh, unprocessed foods like chicken, vegetables, and fruit are naturally low in sodium.
Question 6: A patient receiving total parenteral nutrition (TPN) develops sudden onset of chest pain, dyspnea, and decreased breath sounds on the left. The nurse should first suspect:
- Hypoglycemia from incorrect TPN formulation
- Catheter-related bloodstream infection
- Pneumothorax from central line insertion (Correct answer)
- Air embolism from a disconnected tubing
Correct answer: Pneumothorax from central line insertion
Pneumothorax is a known complication of central venous catheter insertion (required for TPN). Sudden chest pain, dyspnea, and unilateral absent breath sounds after line placement are classic signs. This is a medical emergency requiring immediate intervention.
Nursing Acceleration Challenge Exam I PN Nutrition and Diet Therapy
A nurse is caring for a patient with chronic kidney disease (CKD).
Which dietary modification is most appropriate for this patient?