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Basic Care and Comfort

NCLEX Nutrition Practice Questions

Quick answer

Nutrition questions test whether you can match a diet to a diagnosis and keep a client safe while eating or being fed. They sit inside Basic Care and Comfort, which is 6 to 12 percent of the NCLEX, and nutrition is one of the most reliable places that category pulls from.

  • 10 practice questions
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Most nursing students know far more about food than they think, and that is the problem. The exam does not want what you would serve your own family. It wants the one food on a tray that breaks a renal diet, the one reason a tube feeding gets held, and the one thing a client with dysphagia is never handed. The trap here is picking the "healthy" option. Bananas, oranges, whole grains and fruit juice are great advice for a healthy adult and the wrong answer for a client with a potassium of 5.8 mEq/L or a fresh gluten free diagnosis. Read the diagnosis in the stem first, then read the food list through that lens. The ten questions below cover therapeutic diets, enteral feeding safety, aspiration precautions, liquid diet stages, food sources for a deficiency, drug and food interactions, and the NPO rules students mix up before procedures.

Practice questions

1

A client with chronic kidney disease on hemodialysis is choosing lunch from the menu. The nurse should intervene when the client selects which item?

  1. AGrilled chicken breast with white rice
  2. BA baked potato with sour cream and a glass of orange juice
  3. CApple slices with a small dinner roll
  4. DGreen beans with unsalted butter
Show answer

Answer: B

A renal diet limits potassium, phosphorus and sodium because failing kidneys cannot clear them. Potatoes and orange juice are both very high in potassium, and dairy such as sour cream adds phosphorus, so this tray is the one to stop.

Why the others are wrong

White rice and a plain chicken portion (A) are low in potassium and acceptable in controlled amounts. Apples and white bread (C) are among the lower potassium fruit and starch choices. Green beans (D) are a low potassium vegetable, and unsalted butter adds no sodium.

2

A client with heart failure on a 2 gram sodium diet asks the nurse which foods to avoid at home. Which statement by the client shows the teaching was understood?

  1. A"I will choose canned soup instead of fresh because it has fewer calories."
  2. B"Deli turkey and cheese slices are a good low sodium lunch."
  3. C"I should read labels on frozen dinners and pick fresh or frozen plain vegetables over canned."
  4. D"I can use as much soy sauce as I like as long as I do not add table salt."
Show answer

Answer: C

Most sodium in the diet comes from processed and packaged food, not the salt shaker. Reading labels and choosing fresh or plain frozen produce over canned is the core of a cardiac diet.

Why the others are wrong

Canned soup (A) is one of the highest sodium items in a grocery store. Processed deli meat and cheese (B) are heavily salted during curing. Soy sauce (D) contains roughly 900 mg of sodium per tablespoon, so skipping table salt does not make it safe.

3

A client newly diagnosed with celiac disease is reviewing a sample menu with the nurse. Which food can the client safely eat?

  1. AWhole wheat toast with jam
  2. BBarley and vegetable soup
  3. CPlain baked chicken with steamed rice and corn
  4. DPasta with marinara sauce
Show answer

Answer: C

Celiac disease requires removing gluten, the protein in wheat, barley and rye. Rice, corn, potatoes, plain meat, fruit and vegetables are naturally gluten free.

Why the others are wrong

Wheat toast (A) and standard pasta (D) are made from wheat flour. Barley (B) contains gluten, and it hides in soups, malt flavoring and many beers. Oats are also risky unless labeled gluten free because of cross contamination during processing.

4

A client who had a gastrectomy 2 weeks ago reports cramping, sweating and a racing heart about 20 minutes after each meal. The nurse reviews the plan to reduce dumping syndrome. Which instruction is correct?

  1. A"Drink a full glass of water with every meal to help the food pass."
  2. B"Eat six small meals a day and lie down for 20 to 30 minutes after eating."
  3. C"Walk for 15 minutes right after each meal to slow digestion."
  4. D"Choose high sugar foods such as juice and pudding because they are easy to digest."
Show answer

Answer: B

Dumping syndrome happens when a large, concentrated load of food rushes into the small intestine. Small frequent meals and resting flat or semi recumbent after eating slow the emptying and ease the symptoms.

Why the others are wrong

Fluids with meals (A) push food through faster, so liquids are taken 30 to 60 minutes before or after eating. Walking after meals (C) speeds gastric emptying, which is the opposite of the goal. Simple sugars (D) pull fluid into the bowel and trigger the symptoms, so the diet is higher in protein and fat and low in simple carbohydrates.

5

A nurse is preparing to start an intermittent feeding through a nasogastric tube. Which action should the nurse take first?

  1. AFlush the tube with 30 mL of water
  2. BRaise the head of the bed to 30 degrees or higher
  3. CVerify tube placement according to facility policy
  4. DWarm the formula to room temperature
Show answer

Answer: C

Nothing goes into a feeding tube until the nurse has confirmed it is still in the stomach. For an NG tube that means checking the external marking at the nares and, where policy allows, checking gastric pH, with x ray as the gold standard after initial placement. A displaced tube can put formula straight into the lungs.

Why the others are wrong

Flushing (A) comes after placement is confirmed and again after the feeding to keep the tube open. Elevating the head of the bed (B) is required during and for 30 to 60 minutes after feeding to reduce aspiration, but it does not matter if the tube is in the wrong place. Formula at room temperature (D) reduces cramping but is a comfort step, not a safety step.

6

A client receiving continuous tube feeding at 60 mL per hour has a gastric residual volume of 450 mL when the nurse checks. The client denies nausea. Which action is correct?

  1. AReturn the residual, hold the feeding and notify the provider
  2. BDiscard the residual and restart the feeding at the same rate
  3. CReturn the residual and increase the rate to catch up
  4. DStop the feeding and remove the tube
Show answer

Answer: A

A residual that is more than 250 to 500 mL (depending on facility policy) or far above the hourly rate suggests the stomach is not emptying. The residual is returned so the client does not lose fluid and electrolytes, the feeding is held, and the provider is told so the rate, formula or a prokinetic can be reviewed.

Why the others are wrong

Discarding the residual (B) wastes gastric secretions and electrolytes, and restarting at the same rate ignores the problem. Increasing the rate (C) would add more volume to a stomach that is already not emptying and raises aspiration risk. Removing the tube (D) is not a nursing decision and is not indicated for a single high residual.

7

A client who had a stroke 3 days ago has been evaluated by the speech language pathologist and placed on a dysphagia diet with nectar thick liquids. Which action by the UAP should the nurse correct?

  1. APositioning the client upright at 90 degrees before the meal
  2. BHanding the client a cup of thin water with a straw after the meal
  3. CReminding the client to tuck the chin toward the chest when swallowing
  4. DChecking the mouth for pocketed food after the meal
Show answer

Answer: B

Thin liquids are the hardest consistency for a client with dysphagia to control, and a straw sends the liquid to the back of the throat before the swallow is ready. Every liquid, including water, must be thickened to the ordered consistency, and straws are generally avoided.

Why the others are wrong

Sitting fully upright (A) protects the airway and is correct. A chin tuck (C) narrows the airway entrance and helps direct food down the esophagus. Checking for pocketed food (D) catches residue that could be aspirated once the client lies back.

8

A client is advanced to a full liquid diet after bowel surgery. Which item on the tray is NOT appropriate for this diet?

  1. ACream of tomato soup, strained
  2. BVanilla pudding
  3. CScrambled eggs
  4. DOrange juice without pulp
Show answer

Answer: C

A full liquid diet includes anything that is liquid or melts to liquid at room temperature: milk, strained cream soups, pudding, custard, ice cream, yogurt without fruit pieces, and all clear liquids. Scrambled eggs are a solid and belong on a soft or regular diet.

Why the others are wrong

Strained cream soup (A) and pudding (B) are classic full liquid items. Pulp free juice (D) is a clear liquid, and everything on a clear liquid diet (broth, gelatin, apple juice, tea, popsicles) is also allowed on a full liquid diet.

9

A client taking phenelzine for depression tells the nurse at a clinic visit that she has started a new meal plan. Which food choice should the nurse tell her to avoid?

  1. AFresh grilled salmon with lemon
  2. BAged cheddar cheese and salami on crackers
  3. CCottage cheese with fresh pineapple
  4. DPlain rice with steamed broccoli
Show answer

Answer: B

Phenelzine is an MAOI. Foods high in tyramine (aged cheeses, cured and fermented meats, sauerkraut, soy sauce, tap beer, red wine, overripe fruit) can trigger a hypertensive crisis with a severe headache and a sharp rise in blood pressure.

Why the others are wrong

Fresh fish (A), cottage cheese and fresh fruit (C), and plain rice and vegetables (D) are low in tyramine. The rule is that fresh, unaged, unfermented foods are safe, while anything aged, cured, pickled or spoiled is not.

10

A client with a history of gout asks the nurse which foods to limit to prevent another flare. Which response by the nurse is correct?

  1. A"Limit organ meats, shellfish, sardines and beer, and drink plenty of water."
  2. B"Avoid dairy products, because milk raises uric acid."
  3. C"Cut out all vegetables, since they are high in purines."
  4. D"Eat more red meat for protein, but skip fruit and juice."
Show answer

Answer: A

Gout comes from uric acid crystals, and uric acid is made from purines. Organ meats, shellfish, oily fish such as sardines and anchovies, and alcohol (especially beer) are the biggest purine sources. Fluids help flush uric acid through the kidneys.

Why the others are wrong

Low fat dairy (B) is actually protective in gout and is encouraged. Most vegetables (C) have little effect on uric acid even when they contain some purines. Red meat (D) is high in purines and should be limited, while fruit is allowed, although high fructose drinks are best kept low.

Quick tips

  • Renal diet means low potassium, low phosphorus, low sodium and often restricted protein and fluids. High potassium foods to flag: bananas, oranges, potatoes, tomatoes, dried fruit, spinach and salt substitutes. High phosphorus: dairy, nuts, cola, processed meats.
  • For an iron deficiency, pair red meat, liver, beans, fortified cereal and dark leafy greens with a source of vitamin C to increase absorption, and keep tea, coffee and calcium away from the iron rich meal.
  • Tube feeding order of operations: confirm placement, head of bed at least 30 degrees, check residual, flush, feed, flush again. Keep the head up for 30 to 60 minutes after an intermittent feeding.
  • Clear liquid means you can see through it (broth, gelatin, apple or cranberry juice, tea, black coffee, popsicles). Full liquid adds anything that pours or melts (milk, cream soup, pudding, ice cream, yogurt). Milk is never a clear liquid.
  • Standard NPO rules before anesthesia are usually clear liquids up to 2 hours before, a light meal up to 6 hours before, and a heavy or fatty meal 8 hours before. Follow the order on the chart, and if a client ate when they should not have, the surgeon and anesthesia are notified before the client leaves the unit.

Related topics

FAQ

What foods should a client on a renal diet avoid on the NCLEX?

Think potassium first: bananas, oranges, potatoes, tomatoes, avocados, dried fruit and salt substitutes. Then phosphorus: dairy, nuts, beans and dark colas. Then sodium: canned, processed and fast food. Low potassium picks are apples, berries, grapes, green beans, white rice and white bread.

How long should a client be NPO before surgery?

Most anesthesia guidelines allow clear liquids until 2 hours before, a light meal until 6 hours before, and a fatty meal until 8 hours before a procedure. On the exam, if the stem says NPO after midnight, go with the order and withhold everything, including gum and hard candy, unless a specific medication is ordered with a sip of water.

What is the difference between a clear liquid and a full liquid diet?

A clear liquid diet is only see through fluids: broth, gelatin, clear juice, tea, popsicles. A full liquid diet keeps all of those and adds milk based items: cream soups, pudding, custard, ice cream, smooth yogurt and milk. Neither includes solid food, so soft scrambled eggs or mashed potatoes are a step above both.

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