Which of the following nutrients provides the most calories per gram?
ACarbohydrates
BProtein
CFat (Lipids)
DFiber
Fat provides 9 cal/g — the most dense energy source. Carbohydrates and protein each provide 4 cal/g. Fiber provides 1.5–2.5 cal/g.
Multiple Choice
Q2
A nurse is teaching a client about carbohydrates. The nurse should explain that the minimum amount of carbohydrates needed daily to fuel the brain is:
A65 g/day
B130 g/day
C200 g/day
D305 g/day
The DRI minimum for carbohydrates to fuel the brain is 130 g/day for adults and children. 305 g/day is the median intake for males ≥20 years.
Multiple Choice
Q3
A nurse explains that glycogen is stored in which of the following locations?
AAdipose tissue and kidneys
BPancreas and spleen
CSmall intestine and liver
DLiver and muscles
Glycogen is the stored form of carbohydrate energy and is found in the liver and muscles. It is a vital but limited backup energy source.
SATA
Q4
A nurse is teaching a client about dietary fiber. Which of the following statements about fiber are correct? (Select all that apply)
AFiber adds bulk to feces and stimulates peristalsis
BThe AI for fiber is 25 g/day for females and 38 g/day for males
CFiber provides 4 cal/g of energy
DFiber helps lower cholesterol and stabilize blood glucose levels
EFiber is categorized as a carbohydrate
A, B, D, E are correct. Fiber provides 1.5–2.5 cal/g (not 4 cal/g — that is for digestible carbohydrates). Fiber is categorized as a carbohydrate, aids elimination, lowers cholesterol, slows glucose absorption, and the AI is 25 g/day (F) and 38 g/day (M).
Multiple Choice
Q5
A client asks about complete versus incomplete proteins. Which food is an example of a complete protein source?
ABlack beans
BBrown rice
CChicken breast
DHummus
Complete proteins come from animal sources and soy and contain all 9 essential amino acids. Black beans, rice, and hummus are incomplete proteins, but combined they can form complementary complete proteins.
SATA
Q6
A nurse is reviewing the metabolic functions of protein with a client. Which of the following are correct functions of protein? (Select all that apply)
ATissue building and maintenance
BSupport of the immune system
CFormation of neurotransmitters and enzymes
DPrimary energy source for the brain
EFacilitation of acid-base and fluid balance
A, B, C, E are correct. The primary energy source for the brain is carbohydrates (glucose), not protein. Protein serves as a backup energy source.
Multiple Choice
Q7
A client who is a strict vegan asks what food combinations will provide a complete protein. The nurse should suggest:
ABlack beans and rice
BApples and peanut butter
COatmeal and orange juice
DBroccoli and carrots
Black beans and rice are complementary proteins — two incomplete proteins that together provide all 9 essential amino acids. They do not need to be eaten at the same meal; consuming a variety throughout the day is sufficient.
Multiple Choice
Q8
Which lipoprotein is responsible for removing excess cholesterol from cells and transporting it to the liver for disposal?
AVLDL
BLDL
CHDL
DChylomicron
HDL (High-Density Lipoprotein) removes excess cholesterol from cells → liver for disposal ("good" cholesterol). LDL carries cholesterol to tissue cells. VLDL carries triglycerides to cells.
SATA
Q9
A nurse is teaching about fat-soluble vitamins. Which of the following statements are correct? (Select all that apply)
AFat-soluble vitamins can cause toxicity because they are stored long-term in the body
BFat-soluble vitamins include A, C, D, and K
CClients with cystic fibrosis or Crohn's disease are at risk for fat-soluble vitamin deficiency
DVitamin K can be used as an antidote for excess warfarin
EVitamin A in retinoid form can have teratogenic effects in pregnancy
A, C, D, E are correct. The fat-soluble vitamins are A, D, E, and K — not Vitamin C (which is water-soluble). Fat-soluble vitamins require dietary fat for absorption, so any condition affecting fat absorption (cystic fibrosis, celiac, Crohn's, intestinal bypass) puts clients at risk.
Multiple Choice
Q10
A client presents with sun-sensitive skin lesions, GI issues, and neurologic findings including confusion and insomnia. Which vitamin deficiency should the nurse suspect?
AThiamin (B1)
BNiacin (B3)
CFolate
DCobalamin (B12)
Niacin (B3) deficiency causes pellagra — characterized by sun-sensitive skin lesions, GI issues (impaired digestion, absorption), and neurologic findings (anxiety, insomnia, confusion, paranoia). Thiamin deficiency causes beriberi.
Multiple Choice
Q11
A pregnant client asks the nurse why folate is so important before and during pregnancy. The nurse's best response is:
A"Folate prevents pernicious anemia in the newborn."
B"Folate supports fat metabolism and energy production."
C"Folate prevents scurvy and tissue breakdown."
D"Folate is needed to prevent neural tube defects, which form early in pregnancy."
Folate is required for new cell synthesis and prevention of neural tube defects (spina bifida, anencephaly). Neural tube formation occurs early in gestation — often before the client knows she is pregnant. All clients of childbearing age should get adequate folate.
Multiple Choice
Q12
A nurse is caring for a client who follows a strict vegan diet and presents with fatigue, poor muscle coordination, and paresthesia of the hands and feet. Which deficiency should the nurse suspect?
AVitamin C
BCobalamin (B12)
CFolate
DNiacin (B3)
Cobalamin (B12) deficiency causes pernicious anemia, GI findings, poor muscle coordination, and paresthesia of hands and feet. B12 is found only in animal-origin foods, putting strict vegans at high risk. Intrinsic factor absence also causes B12 deficiency.
SATA
Q13
A nurse is reviewing minerals with a group of nursing students. Which of the following statements about potassium are correct? (Select all that apply)
ABoth deficiency and excess can cause dysrhythmias
BPotassium is primarily regulated by monitoring blood pressure
COral potassium preparations should be given with meals to minimize GI irritation
DSources include bananas, oranges, potatoes, tomatoes, and dried fruits
EThe nurse should monitor cardiac status and ECG for potassium imbalances
A, C, D, E are correct. Potassium is monitored via cardiac status and ECG — not blood pressure (that is sodium). Both hypo- and hyperkalemia cause dysrhythmias. Oral preparations are given with meals to reduce GI irritation.
Multiple Choice
Q14
A client has low calcium levels. Which clinical signs should the nurse expect to find? (Select the best answer)
APositive Chvostek's and Trousseau's signs, tetany
BConstipation, renal stones, lethargy
CDysrhythmias, muscle cramps, confusion
DDiarrhea, hypotension, bradycardia
Calcium deficiency causes tetany and positive Chvostek's and Trousseau's signs, ECG changes, osteoporosis (adults), and poor growth (children). The signs in option B are calcium excess findings. Option C is potassium deficiency. Option D is magnesium excess.
SATA
Q15
A nurse is teaching a client about iron intake. Which of the following statements are correct? (Select all that apply)
AHeme iron is found in grains, legumes, and vegetables
BVitamin C increases the absorption of iron
CLiquid iron supplements can cause teeth discoloration
DPregnant clients and those who menstruate are at risk for iron deficiency anemia
EIron supplements can be taken with food to reduce GI side effects
B, C, D, E are correct. Heme iron is found in meat, fish, and poultry — not grains/legumes/vegetables (those are non-heme iron sources). Vitamin C enhances iron absorption. Liquid iron stains teeth. GI effects can be reduced by taking with food.
Multiple Choice
Q16
Which Dietary Reference Intake (DRI) value represents the maximum amount of a nutrient an individual should consume, used when a nutrient has known adverse effects?
ARDA
BEAR
CAI
DUL
UL (Tolerable Upper Intake Level) is the maximum an individual should consume and is used when a nutrient is known to have adverse effects. RDA = recommended for most healthy people. EAR = meets needs for half a population. AI = used when RDA cannot be established.
Multiple Choice
Q17
The nurse is teaching about water intake. Which of the following is the most accurate statement?
AThirst is a reliable early indicator of dehydration in all populations
BThe AI for adult water intake is 1.5 L/day for both males and females
CThirst is a late indicator of dehydration, especially in older adults
DCaffeinated beverages always cause significant fluid loss
Thirst is a LATE indicator of dehydration, especially in older adults. The AI is 2.7 L/day for females and 3.7 L/day for males. 1,500 mL is the minimum daily intake. Caffeinated beverages have a mild diuretic effect, but tolerance develops with regular use, resulting in little to no net fluid loss.
Fill in the Blank
Q18
The AMDR for carbohydrates is ___% to ___% of total daily calories. (Enter as: 45-65)
✅ Correct! The AMDR for carbohydrates is 45–65% of total calories. Fat = 20–35%. Protein = 10–35%.
Fill in the Blank
Q19
The RDA for protein in healthy adults is ___ g/kg of body weight.
✅ Correct! The RDA for protein is 0.8 g/kg for healthy adults. During acute stress or illness, requirements can increase to more than 2 g/kg.
Fill in the Blank
Q20
A deficiency of Vitamin C causes a hemorrhagic disease called ___________.
✅ Correct! Vitamin C deficiency causes scurvy — a hemorrhagic disease with diffuse tissue bleeding, painful limbs/joints, weak bones, and swollen gums/loose teeth.
Multiple Choice
Q21
A nurse is caring for a client with liver disease. What important teaching should the nurse provide regarding fat-soluble vitamins?
A"You should increase your fat-soluble vitamin intake to compensate for liver damage."
B"Do not exceed the daily recommendations for fat-soluble vitamins, as excess is stored in the liver."
C"Water-soluble vitamins pose a greater toxicity risk with liver disease."
D"Fat-soluble vitamins are automatically excreted when intake is too high."
Fat-soluble vitamins (A, D, E, K) are stored in the liver and adipose tissue and can accumulate to toxic levels. Clients with liver disease should not exceed daily recommendations. Water-soluble vitamins are generally excreted and pose less toxicity risk.
Multiple Choice
Q22
Which organ is primarily responsible for the majority of lipid metabolism?
AStomach
BLiver
CSmall intestine
DPancreas
The majority of lipid metabolism occurs in the small intestine. The gallbladder secretes bile (emulsifier) and the pancreas secretes pancreatic lipase — both act in the small intestine to break down fat. Intestinal cells then absorb the end products.
SATA
Q23
A nurse is assessing a client for proper hydration. Which of the following are appropriate assessment parameters? (Select all that apply)
ASkin turgor
BMental status
COrthostatic blood pressures
DUrine output and concentration
EMoistness of mucous membranes
All five are correct. The assessment for proper hydration includes: skin turgor, mental status, orthostatic blood pressures, urine output and concentration, and moistness of mucous membranes.
Multiple Choice
Q24
A client who smokes cigarettes asks about Vitamin C. The nurse should instruct the client to increase Vitamin C intake by how much per day compared to non-smokers?
A15 mg/day
B35 mg/day
C50 mg/day
D100 mg/day
Cigarette smokers are advised to increase Vitamin C intake by 35 mg/day due to increased oxidative stress and metabolic turnover caused by smoking.
Multiple Choice
Q25
Iodine deficiency leads to which of the following conditions?
AFluorosis
BGoiter
CPellagra
DBeriberi
Iodine deficiency causes the thyroid gland to enlarge, creating a goiter. Iodine is used for synthesis of thyroxine. Too much iodine causes thyrotoxicosis. The RDA for iodine is 150 mcg/day for adults.
A nurse is explaining how the body uses energy nutrients. Which of the following correctly describes catabolism?
AThe use of energy to build or repair body substances
BThe breaking down of substances with resultant release of energy
CThe absorption of nutrients into the lymphatic system
DThe conversion of glucose into glycogen for storage
Catabolism = breaking down substances + releasing energy. Anabolism = using energy to build/repair substances. Metabolism = the sum of both processes.
Multiple Choice
Q2
When the body has surplus glucose, it is converted and stored in which of the following ways?
AConverted to protein and stored in muscle
BConverted to cholesterol and stored in the liver
CConverted to fat and stored in adipose tissue
DConverted to urea and excreted by the kidneys
Surplus glucose → converted to fat → stored as triglycerides in adipose tissue. Primary glucose → glycogen in liver and muscle. Amino acids → proteins; liver removes nitrogen → remaining carbon skeleton converted to glucose or fat.
Multiple Choice
Q3
The nurse explains BMR to a client. Which of the following most accurately describes Basal Metabolic Rate (BMR)?
AEnergy used in 24 hr for involuntary activities, measured at rest after a 12-hr fast
BCalories burned during physical activity throughout the day
CEnergy used for involuntary activities at rest, without requiring a 12-hr fast
DThe total calories consumed minus calories expended in a day
BMR (Basal Energy Expenditure) = energy for involuntary activities over 24 hr, measured at rest AFTER a 12-hr fast. RMR (Resting Metabolic Rate) is similar but does NOT require the 12-hr fast.
SATA
Q4
A nurse is reviewing factors that increase BMR with a student. Which of the following correctly increase BMR? (Select all that apply)
ALean, muscular body build
BStarvation and malnutrition
CProlonged stress
DPregnancy and lactation
EExposure to extreme temperatures
A, C, D, E increase BMR. Starvation/malnutrition DECREASES BMR. Other BMR increases: rapid growth (infancy/puberty), physical conditioning. Other BMR decreases: short/overweight body build, age-related loss of lean body mass.
SATA
Q5
A nurse is reviewing prescribed medications. Which medications should the nurse recognize as decreasing BMR? (Select all that apply)
AEpinephrine
BLevothyroxine
COpioids
DBarbiturates
EEphedrine sulfate
Opioids, barbiturates, and muscle relaxants DECREASE BMR. Epinephrine, levothyroxine, and ephedrine sulfate INCREASE BMR. Muscle relaxants also decrease BMR but were not listed here.
Multiple Choice
Q6
A client is admitted following severe burns covering 40% of their body. The nurse should anticipate which of the following nutritional effects?
ADecreased BMR and reduced caloric needs
BDecreased protein catabolism
CIncreased glycogen storage
DIncreased BMR and elevated caloric and protein requirements
Any catabolic illness (surgery, extensive burns) increases BMR and the body's requirement for calories. Stress hormones break down protein rapidly, increasing protein requirements to more than 2 g/kg or up to 25% of total calories depending on age and prior nutritional status.
Multiple Choice
Q7
A nurse is teaching about acute stress and nutrition. Which of the following is the PRIMARY nutritional concern during acute stress?
ACarbohydrate deficiency
BProtein deficiency
CVitamin C deficiency
DFat deficiency
The major nutritional concern during acute stress is PROTEIN deficiency — stress hormones break down protein at a very rapid rate. Protein deficiency increases complications: skin breakdown, delayed wound healing, infections, organ failure, ulcers, impaired medication tolerance.
SATA
Q8
A nurse is caring for a client with protein deficiency from acute stress. Which complications should the nurse recognize as risks? (Select all that apply)
ASkin breakdown
BDelayed wound healing
CInfections
DImpaired medication tolerance
EOrgan failure and ulcers
All five are correct. Protein deficiency from stress increases the risk of all these complications. This is why adequate protein intake is critical during acute illness, surgery, and trauma.
Multiple Choice
Q9
A nurse is caring for a client who is in a stable nitrogen balance. Which of the following best describes this state?
AThe body is building more tissue than it is breaking down
BThe body is breaking down more tissue than it is building
DThe client is in a catabolic state with insufficient protein intake
Neutral nitrogen balance = intake equals excretion = adequate nutritional intake in a healthy, stable adult. Positive balance = building more than breaking (growth, pregnancy). Negative balance = breaking more than building (starvation, illness, trauma).
SATA
Q10
A nurse is caring for a client with a negative nitrogen balance. Which of the following are possible causes? (Select all that apply)
ACritical illness
BStarvation
CAdolescence
DTrauma
EPregnancy
A, B, D are correct. Critical illness, starvation, and trauma cause negative nitrogen balance (protein breakdown exceeds synthesis). Adolescence and pregnancy cause POSITIVE nitrogen balance (rapid growth/building).
Multiple Choice
Q11
Which of the following physiological states is associated with a POSITIVE nitrogen balance?
AAging
BMalnutrition
CProlonged illness
DInfancy
Positive nitrogen balance occurs during periods of growth: infancy, childhood, adolescence, pregnancy, and lactation. The body is building more tissue than it breaks down. Aging, malnutrition, and prolonged illness cause negative nitrogen balance.
Fill in the Blank
Q12
Thyroid function tests can be used as an indirect measure of ___________.
✅ Correct! Thyroid function tests can be used as an indirect measure of BMR (Basal Metabolic Rate), since the thyroid regulates metabolic rate.
Multiple Choice
Q13
A nurse is reviewing energy use priorities with a client. In what order does the body use its energy sources?
AATP → glycogen → stored fat
BStored fat → glycogen → ATP
CGlycogen → ATP → stored fat
DProtein → glycogen → ATP
Body cells first use available ATP for growth and repair, then use glycogen, then stored fat. This is the priority order for energy utilization.
SATA
Q14
A nurse is completing a nutritional assessment. Which of the following should be included in the data collection? (Select all that apply)
DMedication adverse effects that can affect nutrition
EClinical findings of malnutrition (pitting edema, hair loss, wasted appearance)
All five are correct. A complete nutritional assessment also includes medical history, extent of traumatic injuries, fluid/electrolyte status, usual 24-hr dietary intake, and use of supplements/herbal products.
Fill in the Blank
Q15
To boost protein and caloric intake, a nurse can instruct a client to add skim milk powder to milk to make ___________ milk.
✅ Correct! Adding skim milk powder to milk creates double-strength milk — a simple strategy to increase protein and caloric content. Other strategies: whole milk instead of water in recipes, adding cheese/peanut butter/eggs/yogurt to foods.
Multiple Choice
Q16
A nurse is teaching about conditions that increase metabolic demands. Which condition DECREASES metabolism?
AFever
BHyperthyroidism
CHypothyroidism
DCancer
Hypothyroidism is the primary condition that DECREASES metabolism. Fever, hyperthyroidism, cancer, cardiac failure, burns, surgery/wound healing, HIV/AIDS, shivering, and Parkinson's disease all INCREASE metabolism.
Multiple Choice
Q17
Which of the following best describes absorption as it relates to nutrition?
AThe process of consuming food by mouth and moving it through the digestive system
BNutrients passing through the digestive system into the bloodstream and lymphatic system
CThe chemical breakdown of food into smaller components for digestion
DAll chemical processes at the cellular level to maintain homeostasis
Absorption = nutrients passing through the digestive system into the bloodstream and lymphatic system. Ingestion = consuming food by mouth. Digestion = breakdown of nutrients. Metabolism = all chemical processes at cellular level.
Fill in the Blank
Q18
In a healthy adult male, generally has a higher metabolic rate than a female due to a higher amount of body ___________ and decreased amount of fat.
✅ Correct! Males assigned at birth generally have a higher metabolic rate due to higher muscle mass and decreased fat. Lean body mass increases BMR.
Multiple Choice
Q19
A nurse is explaining how amino acids are processed for energy. What does the liver do with amino acids when they are used for energy?
AStores them directly as glycogen
BRemoves nitrogen; the remaining product is converted to glucose or fat
CConverts them directly to ATP without byproducts
DExcretes them unchanged through the kidneys
The liver removes nitrogen from amino acids; the remaining carbon skeleton is converted to glucose or fat for energy. This is why protein catabolism generates urea (from nitrogen) which is excreted in urine.
SATA
Q20
A nurse is educating a client about factors that affect BMR. Which factors are correctly matched? (Select all that apply)
ALean body mass increases BMR
BAge-related loss of lean body mass decreases BMR
CRapid growth periods such as infancy and puberty increase BMR
DBody surface area, age, and sex are factors that contribute to BMR
EPhysical conditioning increases BMR
All five are correct. BMR is affected by lean body mass, hormones, body surface area, age, and sex. Males generally have higher BMR due to more muscle and less fat. Physical conditioning builds lean muscle mass, which increases BMR over time.
Multiple Choice
Q21
A client with Parkinson's disease and involuntary muscle tremors asks why they seem to need more calories. The nurse explains this is because:
AParkinson's disease reduces appetite leading to compensatory caloric needs
BParkinson's disease decreases metabolism requiring more food to feel full
CInvoluntary muscle tremors increase metabolism and caloric expenditure
Involuntary muscle tremors (shivering, Parkinson's) increase metabolism because continuous uncontrolled muscle activity requires energy expenditure. This is why conditions causing involuntary movement are listed as conditions that increase metabolism.
Fill in the Blank
Q22
A healthy adult experiencing a stable weight is in nitrogen ___________, also known as neutral nitrogen balance.
✅ Correct! A healthy adult at stable weight is in nitrogen equilibrium (neutral nitrogen balance) — intake equals excretion. Positive balance = growth/pregnancy. Negative balance = illness/starvation/aging/trauma.
Multiple Choice
Q23
A nurse is reviewing strategies to increase protein and caloric content of a client's diet. Which option is MOST effective?
AReplace meals with high-sugar fruit juices
BUse water instead of milk when cooking
CLimit egg and dairy intake to reduce fat
DAdd skim milk powder to milk (double-strength milk) and add cheese, peanut butter, or yogurt to foods
Correct strategies to boost protein and calories: double-strength milk (add skim milk powder), use whole milk instead of water in recipes, add cheese/peanut butter/hard-boiled eggs/yogurt, dip meats in eggs or milk then breadcrumbs. Nuts and dried beans are good protein alternatives for dairy allergy/lactose intolerance.
SATA
Q24
A nurse is reviewing how energy nutrients are stored in the body. Which of the following correctly describe storage and use of energy nutrients? (Select all that apply)
AGlucose is converted to glycogen and stored in liver and muscle tissue
BSurplus glucose is converted to fat stored in adipose tissue
CGlycerol and fatty acids are reassembled into triglycerides for adipose storage
DAmino acids make body proteins after liver removes nitrogen
EThe body uses stored fat before glycogen when energy is needed
A, B, C, D are correct. The body uses energy in this order: available ATP first → then glycogen → then stored fat. So E is WRONG — glycogen is used BEFORE stored fat. All other statements correctly describe energy nutrient storage.
Multiple Choice
Q25
During a nutrition assessment, the nurse notes a client has pitting edema, hair loss, and a wasted appearance. These are clinical findings of which condition?
ADehydration
BMalnutrition
CVitamin D toxicity
DHypernatremia
Pitting edema, hair loss, and wasted appearance are classic clinical findings of malnutrition. Other findings include dry skin, poor wound healing, muscle wasting, and general weakness. Lab values associated with malnutrition include low albumin, transferrin, and altered glucose/creatinine.
The Joint Commission (TJC) requires a nutrition screening within how many hours of inpatient admission?
A12 hours
B24 hours
C48 hours
D72 hours
TJC requires a nutrition screening within 24 hours of admission to an inpatient facility, with referral to a dietitian for clients at risk for malnutrition.
SATA
Q2
A nurse is completing a diet history. Which of the following are components of a diet history? (Select all that apply)
ATime, type, and amount of food eaten at each meal
BFoods avoided due to allergy or preference
CFrequency and dose of medications or nutritional supplements
DSatisfaction with diet over a specified time frame
ENumber of meals eaten away from home
All five are correct components of a diet history. Also included: type/amount of all fluids, typical food preparation methods, special/celebration foods, and type of preferred or prescribed diet.
SATA
Q3
A nurse is performing a physical assessment on a malnourished client. Which of the following findings should the nurse expect? (Select all that apply)
ADry or brittle hair
BPoor wound healing or sores
CLack of subcutaneous fat or muscle wasting
DGeneral weakness or impaired coordination
EEnlarged spleen or liver
All five are correct manifestations of malnutrition found on physical exam. Also includes: dry skin patches and irregular cardiovascular measurements (HR, rhythm, BP).
Multiple Choice
Q4
A nurse is calculating ideal body weight for a female client who is 5 ft 3 in tall using the Hamwi method. What is her ideal body weight?
A100 lb
B110 lb
C115 lb
D120 lb
Hamwi for females: 100 lb for first 5 ft + 5 lb per extra inch. 5'3" = 100 + (3×5) = 100 + 15 = 115 lb. For males: 106 lb for first 5 ft + 6 lb per extra inch.
Multiple Choice
Q5
A client weighed 180 lb one month ago and now weighs 168 lb. The nurse calculates the percentage of weight change. Which of the following is correct?
A5.6%
B6.7%
C7.5%
D8.3%
% Weight change = (Usual wt − Present wt) ÷ Usual wt × 100 = (180 − 168) ÷ 180 × 100 = 12 ÷ 180 × 100 = 6.7%. A loss of >5%/month indicates severe malnutrition in chronic disease.
Multiple Choice
Q6
A client has a BMI of 27.5. How should the nurse classify this client?
AHealthy weight
BOverweight
CObese
DUnderweight
BMI 25–29.9 = Overweight. Underweight: <18.5. Healthy: 18.5–24.9. Obese: ≥30. BMI = weight (kg) ÷ height (m²). Note: large muscle mass can elevate BMI without excess fat.
SATA
Q7
A nurse is reviewing weight loss thresholds for a client with a chronic disease. Which findings indicate SEVERE malnutrition? (Select all that apply)
AWeight loss of 3% over 1 month
BWeight loss of greater than 5% over 1 month
CWeight loss of greater than 10% over 6 months
DWeight loss of greater than 20% over 1 year
EWeight loss of 2% over 1 week (chronic disease)
B, C, D indicate severe malnutrition in chronic disease/starvation. Thresholds: >5%/month, >7.5%/3 months, >10%/6 months, >20%/year. For acute disease/injury: >2%/week, >5%/month, >7.5%/3 months. Option E (2%/week) indicates severe malnutrition for ACUTE disease, not chronic.
Multiple Choice
Q8
A nurse is reviewing lab values. Which of the following is the expected reference range for serum albumin?
A1.5–3.5 g/dL
B2.5–4.5 g/dL
C3.5–5 g/dL
D5–7 g/dL
Normal serum albumin = 3.5–5 g/dL. It measures protein levels but is affected by non-nutritional factors (injury, kidney disease). Prealbumin (15–36 mg/dL) is more sensitive for acute changes; <10.7 mg/dL = severe nutritional deficiency.
Multiple Choice
Q9
A nurse is assessing a critically ill client for malnutrition. Which lab value is MOST sensitive for detecting acute nutritional changes?
ATotal protein
BSerum albumin
CHemoglobin
DPrealbumin (thyroxine-binding protein)
Prealbumin is the most sensitive measure for acute changes and is used for critically ill clients at risk for malnutrition. It reflects acute changes (unlike albumin which is more gradual). It is also used to monitor TPN effectiveness. However, it is more expensive and not routine — and can decrease with inflammation.
Fill in the Blank
Q10
To calculate nitrogen balance, 24-hr protein intake in grams is divided by ___ to get nitrogen intake.
A nurse on an orthopedic unit reviews data for a trauma client. Which value indicates the client is in a catabolic state?
AAlbumin 3.5 g/dL
BNegative nitrogen balance
CBMI of 18.5
DPrealbumin 15 mg/dL
Negative nitrogen balance indicates the client is in a catabolic state — protein is being used faster than it is being synthesized. Albumin 3.5, BMI 18.5, and prealbumin 15 mg/dL are all within normal ranges.
SATA
Q12
A nurse is identifying risk factors for inadequate nutrition. Which of the following are biophysical risk factors? (Select all that apply)
BMedical disease or condition (hypertension, HIV/AIDS)
CNegative self-concept causing avoidance of eating
DUse of medications or supplements as part of disease treatment
EExcessive stress leading to comfort food intake
A, B, D are biophysical factors. Negative self-concept and excessive stress are PSYCHOLOGICAL risk factors. Biophysical also includes age and surgery.
Multiple Choice
Q13
A client has limited transportation and lives in a neighborhood with few grocery stores. Which Social Determinant of Health (SDOH) category does this best represent?
ANeighborhood and Built Environment
BEconomic Stability
CEducation
DHealth and Health Care
Neighborhood and Built Environment includes: limited food options in the community, limited transportation affecting ability to obtain groceries, and pollutants in air/soil/water affecting food supply.
Multiple Choice
Q14
A client cannot read food labels due to low literacy. Which SDOH category does this represent?
ANeighborhood and Built Environment
BEconomic Stability
CSocial and Community Context
DEducation
Education SDOH includes: literacy affecting ability to read food labels, education level affecting wages/cost of living, and ability to problem-solve and make healthy food choices.
SATA
Q15
A nurse is teaching about osteoporosis risk factors. Which of the following should the nurse include? (Select all that apply)
AInactivity
BFamily history
CBMI of 30 or greater
DHyperlipidemia
ECigarette smoking
A, B, E are correct. Modifiable osteoporosis prevention: ↑ Vitamin D and calcium, weight-bearing exercise, ↓ tobacco and alcohol. Obesity (BMI ≥30) may actually increase bone density due to weight-bearing effect. Hyperlipidemia is not a direct osteoporosis risk factor.
Multiple Choice
Q16
A nurse is caring for a client on a diuretic and low-sodium diet for edema. Which nutritional concern should the nurse monitor?
AIncreased caloric intake
BSodium and potassium imbalances; reduced appetite from unpalatable diet
CElevated blood glucose levels
DIncreased protein catabolism
Diuretics can cause sodium and potassium imbalances. A low-sodium diet can be unappetizing, causing the client to eat less overall. The nurse should monitor electrolytes and assess nutritional intake adequacy.
Fill in the Blank
Q17
A prealbumin level of less than ___ mg/dL indicates severe nutritional deficiency.
✅ Correct! Prealbumin <10.7 mg/dL indicates severe nutritional deficiency. Normal range is 15–36 mg/dL. Prealbumin can also decrease with an inflammatory process, causing inaccurate readings.
Multiple Choice
Q18
A nurse should plan a client's schedule of activities to achieve which nutritional goal?
AEnsure the client exercises immediately after every meal
CProvide meals only when laboratory values are within normal range
CPrevent interruptions during mealtime and avoid fatigue, nausea, or pain before meals
DSchedule all medications with meals to save time
The nurse should plan activity schedules to prevent interruptions during mealtime and avoid fatigue, nausea, or pain before meals — all of which can reduce nutritional intake.
Multiple Choice
Q19
A nurse is performing a nutritional assessment on admission. Which tool does The Joint Commission (TJC) require be completed within 24 hours?
AComprehensive nutritional assessment by a registered dietitian
B24-hour dietary recall by the provider
CNutrition screening by the nurse, with dietitian referral for at-risk clients
DNitrogen balance calculation and prealbumin level
TJC requires a NUTRITION SCREENING (not a comprehensive assessment) within 24 hours of inpatient admission. Nurses perform the screening. If the client is at risk for malnutrition, a referral to the REGISTERED DIETITIAN is made — the dietitian performs the comprehensive nutritional assessment.
Multiple Choice
Q20
A nurse weighs a client daily. The client's weight increased by 2 kg overnight. The nurse's best interpretation is:
AThis most likely represents a water weight change, not true body mass gain
BThe client has consumed excess calories and needs a dietary restriction
CThe scale is inaccurate and should be replaced
DThe client is developing renal failure
Daily fluctuations in weight generally indicate water weight changes — not true fat or muscle gain. This is why weights should be taken at the same time of day wearing similar clothing. A 2 kg overnight change is almost certainly fluid, not true body mass.
SATA
Q21
A nurse is explaining BMI limitations to a student. Which of the following are correct limitations of BMI? (Select all that apply)
AA client with large muscle mass may have an elevated BMI despite low body fat
BA client with a normal BMI may still have excess body fat
CBMI is the most reliable indicator of cardiovascular risk
DBMI is calculated the same way for children and adults
EBMI always accurately reflects nutritional status
A and B are correct BMI limitations. A muscular client (e.g., athlete) may show overweight/obese BMI despite minimal fat. A thin client may have normal BMI but excess visceral fat. BMI is a screening tool — client factors must always be considered. It is NOT always reliable as a sole indicator of nutritional status or cardiovascular risk.
Multiple Choice
Q22
A male client is 6 feet tall (182.9 cm). Using the Hamwi method, what is his ideal body weight?
A154 lb
B166 lb
C178 lb
D184 lb
Hamwi for males: 106 lb for first 5 ft + 6 lb per extra inch. 6 ft = 12 extra inches. 106 + (12 × 6) = 106 + 72 = 178 lb. For females: 100 lb + 5 lb per extra inch above 5 ft.
Fill in the Blank
Q23
Prealbumin levels can decrease with an ___________ process, resulting in an inaccurate measurement of nutritional status.
✅ Correct! Prealbumin levels can decrease with an INFLAMMATORY process, resulting in an inaccurate measurement of nutritional status. This is an important clinical consideration when interpreting prealbumin in acutely ill clients.
SATA
Q24
A nurse is identifying psychological risk factors for inadequate nutrition. Which of the following are psychological risk factors? (Select all that apply)
AClinical depression
BExcessive stress leading to use of comfort foods
CNegative self-concept causing avoidance of eating or overeating
DAnxiety disorders affecting appetite
ELactose intolerance limiting dairy intake
A, B, C, D are psychological risk factors. Lactose intolerance is a BIOPHYSICAL (genetic predisposition) risk factor, not psychological. Psychological factors: mental illness (clinical depression), excessive stress, negative self-concept, and use of comfort foods.
Multiple Choice
Q25
A client lacks health insurance and cannot afford to see a dietitian for their obesity-related condition. Which SDOH category does this represent?
ANeighborhood and Built Environment
BEconomic Stability
CHealth and Health Care
DSocial and Community Context
Economic Stability SDOH includes: choosing between quality foods vs. housing/education, lack of health insurance limiting access to dietitian, and lack of affordable nutritious food leading to under- or overnutrition. Health and Health Care SDOH covers lack of primary care resources and school nursing.
SATA
Q26
A nurse is planning nursing interventions for a malnourished client. Which of the following are appropriate nursing actions? (Select all that apply)
AMonitor food and fluid intake and output
BCollaborate with the dietitian
CConsult the provider about altering medications that may cause anorexia
DPlan activities to avoid fatigue, nausea, or pain before meals
EProvide adequate calories and high-quality protein
All five are correct nursing interventions for malnourished clients. The nurse should also use a client-centered approach to address disease-specific problems with ingestion, digestion, or medication regimen, and schedule activities to prevent interruptions during mealtime.
The Dietary Guidelines for Americans are published jointly by which two agencies?
AFDA and CDC
BUSDA and HHS
CWHO and NIH
DUSDA and FDA
The Dietary Guidelines for Americans are published jointly by the U.S. Department of Agriculture (USDA) and the U.S. Department of Health and Human Services (HHS) every 5 years.
Multiple Choice
Q2
The 2020–2025 Dietary Guidelines for Americans is unique because it is the first edition to do which of the following?
AInclude recommendations for sodium and alcohol
BBe based on evidence from research studies
CProvide recommendations by life stage from birth through older adulthood
DBe published every 5 years
The 2020–2025 guidelines are the FIRST edition to provide recommendations by life stage, beginning with birth and continuing through older adulthood.
SATA
Q3
A nurse is teaching a client about the core elements of a healthy dietary pattern per the 2020–2025 guidelines. Which of the following should the nurse include? (Select all that apply)
AVegetables of all types including dark green, red/orange, starchy, and legumes
BWhole fruits (especially whole, not juice)
CGrains, with at least half being whole grains
DFat-free or low-fat dairy products
EOils including vegetable oils and oils in seafood and nuts
All five are correct core elements. Protein foods (lean meats, poultry, eggs, seafood, beans, peas, lentils, nuts, seeds, soy) are also a core element.
Multiple Choice
Q4
Based on a 2,000-calorie daily diet, how many cups of vegetables per day does the Dietary Guidelines recommend?
A2 cups
B2½ cups
C3 cups
D3½ cups
Based on a 2,000-calorie diet: Vegetables = 2½ cups/day · Fruits = 2 cups/day · Grains = 6 oz (>3 oz whole grain) · Dairy = 3 cups · Protein = 5½ oz · Oils = 27 g.
SATA
Q5
A nurse is teaching about substances to limit per the Dietary Guidelines. Which of the following are correctly stated? (Select all that apply)
AAdded sugars: less than 10% of calories per day (for those age 2 and older)
BSaturated fat: less than 10% of calories per day (starting at age 2)
CSodium: less than 2,300 mg/day (approximately 1 teaspoon of salt)
DAlcohol: no more than 2 drinks/day for men and 1 drink/day for women
EChildren under age 2 should limit added sugars to less than 5% of calories
A, B, C, D are correct. For children UNDER age 2, added sugars should be AVOIDED entirely — not limited to a percentage. The guidelines state "avoid foods and beverages with added sugars" for those younger than age 2.
Multiple Choice
Q6
A nurse is teaching an infant's parents about the Dietary Guidelines. Which of the following is correct about feeding for the first 6 months of life?
ABegin introducing solid foods at 4 months to establish healthy eating patterns
BSupplement breast milk with added sugars to increase caloric content
CBegin with low-fat dairy products to prevent obesity
DFeed exclusively human milk or iron-fortified infant formula and provide supplemental Vitamin D soon after birth
For the first ~6 months: exclusively human milk or iron-fortified infant formula if human milk is unavailable + supplemental Vitamin D soon after birth. At about 6 months, introduce nutrient-dense complementary foods from all food groups.
Multiple Choice
Q7
A nurse is conducting a nutrition class. Which of the following information should the nurse include?
ALimit saturated fat to less than 10% of total daily caloric intake
BGood bowel function requires 35 g/day of fiber for females
CLimit cholesterol to 400 mg/day
DNormal cardiac function depends on B-complex vitamins
A is correct. Females need 25 g/day fiber (not 35). Current guidelines don't set a specific mg limit for cholesterol. B-complex vitamins support NEUROLOGIC function, not specifically cardiac function.
SATA
Q8
A nurse is counseling a vegan client about potential nutrient deficits. Which nutrients should the nurse emphasize? (Select all that apply)
AVitamin B12
BFiber
CVitamin D
DCalcium
EOmega-3 fatty acids
A, C, D, E are correct vegan deficit risks. Fiber is typically HIGH in plant-based/vegan diets, not deficient. Vegans must be careful about B12 (animal origin only), Vitamin D, calcium, omega-3 fatty acids, iron, and zinc.
Multiple Choice
Q9
A client states they occasionally eat dairy products and eggs but no meat, poultry, or seafood. Which type of vegetarian diet does this describe?
AVegan
BLacto vegetarian
CRaw vegan
DLacto-ovo vegetarian
Lacto-ovo vegetarian = includes dairy AND eggs, excludes meat/poultry/seafood. Lacto vegetarian = dairy only (no eggs). Vegan = no animal products of any kind. Raw vegan = only uncooked plant foods (75–100% uncooked).
SATA
Q10
A nurse is teaching a client how to read food labels. Which of the following nutrients are required to be listed on the Nutrition Facts label? (Select all that apply)
ATotal fat, saturated fat, and trans fat
BVitamin D and potassium
CCalories (in larger bold type)
DDietary fiber and total carbohydrates
ECalcium and iron
All five are correct. Also required: cholesterol, sodium, sugars (g + % DV), protein. Ingredients must be listed in descending order by weight. % Daily Values are based on a 2,000 cal/day diet.
Multiple Choice
Q11
How many major food allergens are manufacturers required to clearly state on food labels?
A5
B6
C8
D10
8 major allergens responsible for 90% of food allergies must be clearly stated: milk, eggs, fish, crustacean shellfish, tree nuts, peanuts, wheat, and soybeans.
SATA
Q12
A nurse is teaching about heart-healthy eating. Which of the following are correct recommendations? (Select all that apply)
ALimit saturated fat to 7% of calories
BThe DASH diet is proven to significantly lower systolic and diastolic BP and LDL cholesterol
CConsume a diet higher in fiber, antioxidants, and unsaturated fats
DLimit red and processed meats, refined grains, and added sugars
ELimit polyunsaturated fats and increase saturated fat intake
A, B, C, D are correct. Option E is WRONG — heart health requires LIMITING saturated fat and emphasizing polyunsaturated fats (omega-3 fatty acids). The DASH diet is evidence-based for reducing hypertension.
SATA
Q13
A nurse is discussing essential nutrients for normal neurologic function. Which of the following should the nurse include? (Select all that apply)
AThiamin (B1)
BCalcium
CVitamin B6
DSodium
EPhosphorus
A, B, C, D are correct. Normal neurologic function depends on B-complex vitamins (especially thiamin/B1, biotin, B6, B12) and calcium and sodium as nerve response regulators. Phosphorus is important for bone health and energy transfer, not specifically neurologic function.
Multiple Choice
Q14
A nurse is teaching a client about cancer prevention through diet. Which recommendation is INCORRECT?
AIncrease high-fiber plant-based foods
BLimit saturated and trans fat; emphasize omega-3 fatty acids
CInclude regular physical activity
DModerate alcohol intake is protective against cancer
D is incorrect — excess alcohol should be AVOIDED for cancer prevention; it is not protective. Correct cancer prevention: high-fiber plant-based foods, limit saturated/trans fat, emphasize omega-3s, limit sodium, avoid excess alcohol, maintain healthy weight, exercise regularly.
Fill in the Blank
Q15
The DASH diet is proven by research to significantly lower systolic and diastolic blood pressure as well as ___________ cholesterol.
✅ Correct! The DASH (Dietary Approaches to Stop Hypertension) diet is evidence-based and proven to significantly lower systolic BP, diastolic BP, and LDL (low-density lipoprotein) cholesterol.
Multiple Choice
Q16
A nurse is advising a client who will be eating at a restaurant tonight. Which strategy aligns with the Dietary Guidelines?
ASkip breakfast to save room for a large restaurant meal
BEat a high-fiber snack about 1 hour before the restaurant meal to decrease hunger
COrder the largest portion size to maximize nutritional value
DAsk for sauces and dressings to be added directly to food for convenience
Eating a high-fiber snack 1 hr before the restaurant meal decreases hunger and helps prevent overeating. Also: if the restaurant meal will be high-calorie, eat lighter meals the rest of the day; ask for high-fat items (dressings, sauces, gravies) on the side.
Fill in the Blank
Q17
Normal bowel function depends on adequate fluid intake and ___ g/day of fiber for females and ___ g/day for males. (Enter as: 25/38)
✅ Correct! Bowel function requires 25 g/day fiber for females and 38 g/day for males, along with adequate fluid intake. This aligns with the AI for fiber from Chapter 1.
Multiple Choice
Q18
A client asks the nurse about organic foods. Which is the most accurate statement?
A"Organic foods are proven to be healthier and more nutritious than conventional foods."
B"Organic livestock can receive antibiotics if they become ill."
C"Organic foods reduce exposure to pesticides, but there is no evidence of a health superiority effect."
D"Organic foods are regulated by the FDA."
Organic foods are regulated by the USDA (not FDA). They reduce pesticide exposure and may reduce antibiotic resistance risk, but there is NO evidence they are nutritionally superior. Organic livestock must graze on pasture, be fed 100% organic feed, and receive NO hormones or antibiotics.
SATA
Q19
Q19
A nurse is teaching a client strategies for healthy cooking at home. Which of the following should the nurse recommend? (Select all that apply)
AAdd frozen vegetables or canned legumes to convenience foods to increase nutrition
BDecrease the amount of salt or sodium-containing seasonings when cooking
CBuy side items that increase nutritional value (packaged salad kits, pre-cut fruit, whole-grain bread)
DUse full-sodium canned goods to enhance flavor
ERely on packaged meal kits for complete nutrition since portions are appropriately sized
A, B, C are correct. Full-sodium canned goods should be limited (D is wrong). Portion sizes on packaged meal kits are often SMALL, leading to consuming more than one serving — so they should not be relied on for complete nutrition (E is wrong).
Multiple Choice
Q21
A nurse is explaining organic food regulations. Which agency regulates organic foods in the United States?
AFDA (Food and Drug Administration)
BUSDA (United States Department of Agriculture)
CCDC (Centers for Disease Control and Prevention)
DNIH (National Institutes of Health)
Organic foods are regulated by the USDA. The FDA regulates food labels. Organic standards: no pesticides/synthetic fertilizers, livestock must graze on pasture, fed 100% organic feed, no hormones or antibiotics. GMO foods are not regulated as organic and have not been proven harmful.
SATA
Q22
A nurse is reviewing types of vegetarian diets. Which of the following statements are correct? (Select all that apply)
AA semi-vegetarian (flexitarian) diet is mainly plant-based with occasional meat, poultry, dairy, or fish
BA lacto vegetarian diet includes dairy but not eggs
CA raw vegan diet is based on consuming uncooked plant-based foods (75–100%)
DVegetarian diets can reduce the risk of ischemic heart disease, type 2 diabetes, and certain cancers
EA vegan diet cannot provide adequate protein under any circumstances
A, B, C, D are correct. A vegan diet CAN provide adequate protein with sufficient nuts and legumes (E is wrong). Vegetarian diets can meet all nutrient recommendations with variety and correct portions. Key vegan risk nutrients: B12, Vitamin D, calcium, omega-3s, iron, zinc.
Multiple Choice
Q23
A client asks about ingredients on a food label. The nurse explains that ingredients are listed in what order?
AAlphabetical order
BAscending order by weight (least to most)
CDescending order by weight (most to least)
DOrder of nutritional importance
Ingredients on food labels must be listed in DESCENDING order by weight — the ingredient present in the greatest amount is listed first, the least amount last. This helps consumers identify the primary ingredients in a product.
Fill in the Blank
Q24
The % Daily Values on a Nutrition Facts label are based on a ___________ calorie per day diet.
✅ Correct! % Daily Values on nutrition facts labels are based on a 2,000 calorie per day diet. Individual caloric needs vary, so the % DV is a general reference. Daily recommendations from the Dietary Guidelines are also based on a 2,000-calorie diet.
Multiple Choice
Q25
A nurse is teaching about MyPlate. Which statement about MyPlate is correct?
AMyPlate is published by the FDA and the CDC
BMyPlate provides one standard meal plan for all Americans regardless of age
CMyPlate is available in English only
DMyPlate is USDA-sponsored, available in multiple languages, and provides age- and lifestyle-specific recommendations
MyPlate is sponsored by the USDA (www.myPlate.gov), available in multiple languages, and provides age- and lifestyle-specific information including for pregnant/lactating women and older adults. MyPlate Kitchen offers recipes and budget-friendly healthy eating tips.
SATA
Q26
A nurse is teaching about bones and nutrition. Which of the following recommendations for bone health are correct? (Select all that apply)
AConsuming recommended servings from MyPlate's dairy group provides calcium, magnesium, and phosphorus for bone formation
BWeight-bearing physical activity is essential to decrease osteoporosis risk
CReducing tobacco and alcohol use positively affects bone health
DVitamin C is the primary vitamin required for bone mineralization
EA sedentary lifestyle improves bone density by conserving calcium
A, B, C are correct. Vitamin D (not Vitamin C) assists in calcium/phosphorus absorption and bone mineralization. Sedentary lifestyle DECREASES bone density — weight-bearing exercise is essential. Reducing tobacco and alcohol, increasing Vitamin D and calcium are key osteoporosis prevention strategies.
Chapter 5 — Food Safety | 0 / 0 answered |
Multiple Choice
Q1
A nurse should ensure food is only given to clients who meet which of the following criteria?
AAre ambulatory and able to sit upright independently
BHave a nasogastric tube in place
CAre conscious and have an intact gag or swallow reflex
DHave been NPO for less than 8 hours
To minimize aspiration risk, food should only be given to clients who are conscious and have an intact gag or swallow reflex. Nurses must also monitor swallowing ability in clients with known aspiration risk (post-stroke, post-esophageal anesthesia).
Multiple Choice
Q2
A nurse is reviewing food storage guidelines. What is the maximum time perishable foods should be left at room temperature?
A1 hour
B2 hours
C3 hours
D4 hours
Perishables should NOT be left at room temperature for more than 2 hours. If the temperature is 90°F (32°C) or above, the limit is only 1 hour. Refrigerators should be kept at ≤40°F (4°C).
Multiple Choice
Q3
A nurse is teaching safe food preparation temperatures. Which of the following is the correct internal temperature for chicken?
A145°F (63°C)
B150°F (66°C)
C160°F (71°C)
D165°F (74°C)
Chicken must reach 165°F (74°C). Roasts and steaks = 145°F. Ground beef and egg-containing products = 160°F. All require a 3-minute rest time after cooking.
SATA
Q4
A nurse is teaching a group about foods most associated with foodborne illness. Which of the following should the nurse include? (Select all that apply)
ARaw or undercooked foods of animal origin
BRaw sprouts
CUnpasteurized fruit juice and milk products
DRaw fruits and vegetables contaminated with animal feces
EUncooked food handled by someone who is ill
All five are correct high-risk foods associated with foodborne illness. Remember: viruses cause MOST foodborne illnesses, but bacteria are responsible for MOST deaths from foodborne illness.
Multiple Choice
Q5
A client presents with sudden fever, headache, back pain, and abdominal discomfort. She is 28 weeks pregnant. The nurse suspects which foodborne illness?
ASalmonella
BE. coli O157:H7
CListeria monocytogenes
DNorovirus
Listeria monocytogenes causes sudden fever, diarrhea, headache, back pain, and abdominal discomfort. It is especially dangerous for newborns, pregnant clients, and immunocompromised clients — and can cause stillbirth or miscarriage. Sources: soft cheese, raw milk, undercooked poultry, processed meats, raw vegetables.
Multiple Choice
Q6
A client develops severe abdominal pain and diarrhea after eating an undercooked hamburger. The client is later diagnosed with hemolytic uremic syndrome. Which pathogen is responsible?
ASalmonella
BE. coli O157:H7
CListeria monocytogenes
DNorovirus
E. coli O157:H7 is associated with raw/undercooked meat (especially ground beef) and can cause hemolytic uremic syndrome — manifesting as severe anemia and kidney failure. Salmonella causes headache, fever, abdominal cramping, diarrhea, N&V and can be fatal.
Multiple Choice
Q7
A nurse is teaching about norovirus. Which statement should the nurse include?
AHand sanitizer is sufficient protection against norovirus when handling foods
BPregnant clients are the most susceptible population for norovirus
CNorovirus typically lasts 4–5 days
DThe onset of norovirus is 24–48 hours after exposure
Norovirus onset is 24–48 hours. It is very contagious. Manifestations: projectile vomiting, fever, myalgia, watery diarrhea, headache. Handwashing with soap and water (NOT just hand sanitizer) is required. Pregnant clients are more at risk from Listeria, not specifically norovirus.
Fill in the Blank
Q8
Eggs can be safely stored in their shell in the refrigerator for ___ to ___ weeks. (Enter as: 3-5)
✅ Correct! Eggs can be stored in the shell in the refrigerator for 3–5 weeks. Hard-boiled eggs should be used within 1 week. Ground beef and poultry = 1–2 days. Steaks/chops/roasts = 3–5 days.
Multiple Choice
Q9
Which of the following best differentiates a food allergy from a food intolerance?
AA food allergy occurs every time the client is exposed; food intolerance does not occur consistently and depends on the amount eaten
BA food intolerance always causes anaphylaxis; a food allergy causes only mild GI symptoms
CA food allergy only occurs the first time a food is eaten; subsequent exposures cause tolerance
DFood intolerances involve histamine release; food allergies do not
A food allergy occurs EVERY time the client is exposed and triggers release of serotonin and histamine. Food intolerance does NOT occur consistently and is dependent on the amount of food eaten. Common allergy manifestations: N&V, diarrhea, abdominal distention and pain.
SATA
Q10
A nurse is teaching about the 8 most commonly reported food allergies. Which of the following are included? (Select all that apply)
AMilk and eggs
BPeanuts and tree nuts
CFish and shellfish
DWheat and soybeans
EThese 8 allergens account for 90% of all food allergies
All five are correct. The 8 major allergens: milk, eggs, fish, crustacean shellfish, tree nuts, peanuts, wheat, soybeans — responsible for 90% of food allergies. Some infants react to cow's milk and/or soy but typically outgrow this by age 4.
Multiple Choice
Q11
A client taking warfarin asks if they can eat spinach salad every day. The nurse should explain that foods high in Vitamin K can have which effect on warfarin?
AIncrease the anticoagulant effect, increasing bleeding risk
BDecrease the anticoagulant effect of warfarin
CHave no effect on warfarin — food and medication interactions are rare
DIncrease warfarin absorption and blood levels
Foods high in Vitamin K (dark green vegetables like spinach, eggs, carrots) DECREASE the anticoagulant effect of warfarin. Clients on warfarin should maintain consistent Vitamin K intake — not necessarily eliminate it, but keep it steady.
Multiple Choice
Q12
A client is prescribed the MAOI phenelzine. The nurse should instruct the client to avoid which of the following foods to prevent hypertensive crisis?
AGrapefruit juice
BDark green vegetables
CHigh-protein meats
DAged cheese and smoked meats
Tyramine-rich foods (aged cheese, smoked meats, dried fish, overripe avocados) + MAOIs (phenelzine, selegiline) → hypertensive crisis. Tyramine is metabolized by MAO, so MAOIs block this breakdown, causing dangerous BP elevation. Grapefruit affects drug metabolism (many meds). Dark green veggies affect warfarin.
Multiple Choice
Q13
Grapefruit juice interacts with many medications by having which effect?
ADecreasing blood levels of the medication
BInterfering with metabolism and increasing blood levels of the medication
CBlocking medication absorption entirely
DIncreasing the rate of medication excretion
Grapefruit juice INTERFERES with the metabolism of many medications, resulting in an INCREASED blood level of the medication — which can intensify both the effects and side effects.
SATA
Q14
A nurse is reviewing food storage times. Which of the following are stored correctly? (Select all that apply)
AChicken breast stored in the refrigerator for 4 days
BBacon stored in the refrigerator for 5 days
CHard-boiled eggs stored in the refrigerator for 6 days
DBeef steak stored in the refrigerator for 4 days
EFresh shellfish stored in the refrigerator for 5 days
B, C, D are correct. Chicken = 1–2 days (A is wrong — 4 days is too long). Bacon = 7 days (B is fine at 5). Hard-boiled eggs = 1 week (C is fine at 6 days). Beef steak/roast = 3–5 days (D is fine at 4). Fresh shellfish = 1–2 days (E is wrong — 5 days is too long).
Fill in the Blank
Q15
When taking medications that cause gastric irritation (such as ibuprofen or amoxicillin), the nurse should instruct the client to take these medications ___________.
✅ Correct! Medications that cause gastric irritation (ibuprofen, amoxicillin, some antidepressants like bupropion) should be taken WITH food to avoid gastric upset.
Multiple Choice
Q16
A client taking levodopa for Parkinson's disease asks if diet matters. The nurse should teach the client that consuming high-protein foods will have which effect on levodopa?
AIncrease levodopa absorption and brain transport
BHave no effect on levodopa
CIncrease metabolism of levodopa, decreasing absorption and brain transport
DCause a hypertensive crisis
Foods high in protein increase the metabolism of levodopa, which DECREASES its absorption and the amount transported to the brain — reducing its effectiveness. Clients should be advised about consistent protein intake timing relative to their medication schedule.
Multiple Choice
Q17
Which date on a food package label indicates the FINAL day the product should be used or consumed?
ASell-by date
BUse-by date
CExpiration date
DPack date
Expiration date = final day product should be used or consumed. Sell-by date = final recommended day of sale. Use-by date = how long the product will maintain top quality.
Multiple Choice
Q18
A nurse is reviewing storage times for fish. How long can smoked fish be stored in the refrigerator?
A1–2 days
B3–5 days
C14 days
D30 days
Smoked fish can be stored in the refrigerator for 14 days. Lean/fatty fish and fresh shellfish = 1–2 days. Canned fish (opened) = 3–4 days in refrigerator, 5 years in pantry (unopened). Refrigerator temp must be maintained at ≤40°F (4°C).
SATA
Q19
A nurse is assessing a client for food allergies versus food intolerance. Which of the following statements about food allergies are correct? (Select all that apply)
AA food allergy occurs every time the client is exposed to the food
BFood allergies initiate the release of serotonin and histamine
CSome infants allergic to cow's milk and/or soy typically outgrow the sensitivity by age 4
DFood intolerances occur every time the client consumes the food regardless of amount
EFood allergies and food intolerances are clinically identical
A, B, C are correct. Food INTOLERANCES do NOT occur consistently and are dependent on the AMOUNT of food eaten (D is wrong). Food allergies and intolerances are clinically different — allergies involve immune response with histamine/serotonin release; intolerances typically involve digestive sensitivity (E is wrong).
Multiple Choice
Q20
A nurse is reviewing canned goods during a home visit. Which canned goods should the nurse advise the client to discard?
ACans stored in a cool, dry pantry
BCans purchased less than 6 months ago
CCans with a slight dust on the exterior from storage
DCans that are dented, rusted, or have stickiness on the outside
Damaged cans (dented, rusted, crushing) and those with stickiness on the outside (indicating leakage) should never be used. Stickiness on the outside of a can can indicate leakage of contents. These signs suggest compromised seal integrity and potential bacterial contamination.
Fill in the Blank
Q21
After cooking, roasts and steaks require a minimum internal temperature of ___°F and a ___ minute rest time. (Enter as: 145/3)
✅ Correct! Roasts and steaks = 145°F (63°C) + 3-minute rest. Chicken = 165°F. Ground beef and egg-containing products = 160°F. All require a 3-minute rest time after cooking to allow temperature to equalize throughout.
Multiple Choice
Q22
Which bacterial foodborne illness is most associated with raw or undercooked GROUND BEEF and can cause hemolytic uremic syndrome with kidney failure?
ASalmonella
BE. coli O157:H7
CListeria monocytogenes
DNorovirus
E. coli O157:H7 is specifically associated with raw/undercooked ground beef and can cause hemolytic uremic syndrome (severe anemia + kidney failure). Salmonella can be fatal but does not typically cause HUS. Listeria is most dangerous to pregnant clients and immunocompromised. Norovirus is viral.
SATA
Q23
A nurse is completing a food safety nursing assessment. Which of the following should be included? (Select all that apply)
AComplete dietary profile of the client
BMedications and herbal supplements
CBaseline knowledge about food safety
DKnowledge about food-medication interactions
EIdentification of food allergies
All five are correct components of the nursing food safety assessment. Nursing interventions should then include basic teaching about food safety and interactions between food and client medications, and teaching the difference between food intolerance and food allergy.
Multiple Choice
Q24
A nurse is teaching a client about herbal supplements and medications. Which statement is most accurate?
AHerbal supplements are natural and therefore always safe to take with medications
BHerbal supplements must be approved by the FDA before being sold
CHerbal supplements can cause potential interactions with prescribed medications and must be discussed with the provider
DOnly pharmaceutical medications cause food-drug interactions, not herbal products
Herbal supplements can cause potential interactions with prescribed medications. It is important that any herbal medication consumed by a client be discussed with the provider. "Natural" does not mean safe — many herbal supplements have significant drug interactions (e.g., St. John's Wort with antidepressants, garlic with anticoagulants).
Multiple Choice
Q25
When food DECREASES the rate of medication absorption, what is the clinical effect?
AThe medication reaches peak effect faster
BThe onset of peak effects is delayed
CThe medication is completely blocked from being absorbed
DThe medication is excreted unchanged
Reducing the RATE of absorption delays the onset of peak effects (takes longer to work). Reducing the EXTENT of absorption reduces the intended effect of the medication. Food can also INCREASE absorption of some drugs, improving peak effects — this depends on the specific medication.
A nurse is providing culturally competent nutritional care. Which term describes the process of a cultural group adopting the dominant culture's behaviors, beliefs, and values?
AEthnocentrism
BAcculturation
CFoodway
DAssimilation
Acculturation = process of a cultural, ethnic, or religious group adopting the dominant culture's behaviors, beliefs, and values. Ethnocentrism = judging other cultures by one's own standards. Foodway = the role of foods, preparation methods, what is considered edible, meal timing, and food as health or benefit.
Multiple Choice
Q2
A client describes foods they eat every day as the foundation of their diet. According to the cultural food role categories, these foods are classified as:
ACore foods
BSecondary foods
CPeripheral foods
DComplementary foods
Core foods = eaten most often and consistently; make up the majority of dietary intake. Secondary foods = included often but less than core. Peripheral foods = eaten occasionally due to cost, availability, or special occasions.
SATA
Q3
A nurse is teaching about cultural influences on food. Which of the following are correct regarding food symbolism across cultures? (Select all that apply)
AFood can represent expressions of love or punishment
BFood may be part of celebration or mourning rituals
C"Comfort foods" can relate to a client's past experiences
DFood can represent masculinity or femininity
EFood can represent connectedness or separateness
All five are correct. Culture gives food symbolic meaning beyond nutrition — it can represent gender roles, love/discipline, social connection, and cultural identity. Understanding this helps nurses provide truly client-centered care.
Multiple Choice
Q4
A Hispanic/Latinx client uses cinnamon tea when ill. The nurse understands this practice is related to which health belief system?
AYin and yang balance
BAhimsa (non-harm to living creatures)
CHot and cold food balance for healing
DMacrobiotic whole-foods philosophy
Hispanic/Latinx culture views certain foods as hot or cold and uses them to provide balance for healing. Cinnamon and teas (mint, chamomile) are used as part of healing practices. Yin/yang balance is an Asian and Pacific Islander belief.
SATA
Q5
A nurse is reviewing nutrition-related concerns for Hispanic/Latinx clients. Which of the following are accurate? (Select all that apply)
AHigh prevalence of obesity
BMore than twice as likely to develop type 2 diabetes mellitus
CIncreased intake of saturated fat and sodium
DDecreased intake of whole grains and milk
ELowest obesity prevalence among all minority groups
A, B, C, D are correct. Hispanic/Latinx clients have HIGH obesity prevalence and >2× risk of Type 2 DM, ↑ saturated fat/sodium, ↓ whole grains and milk, but ↑ fruit, dark green/orange veggies, and legumes. The LOWEST obesity prevalence belongs to Asian American/Pacific Islanders.
Multiple Choice
Q6
Which minority group in the U.S. has the HIGHEST prevalence of obesity and the highest rates of uncontrolled hypertension?
AHispanic/Latinx
BBlack/African American
CAsian American/Pacific Islander
DNative American
Black/African American clients have the HIGHEST prevalence of obesity, increased rates of diabetes with higher complications, and increased risk for hypertension (usually uncontrolled). Food habits are tied more to personal factors (work schedule, location, SES) than heritage.
Multiple Choice
Q7
Asian American/Pacific Islander clients believe diseases associated with yin forces should be treated by consuming which type of foods?
AYin foods such as seaweed and cold beverages
BYang foods such as fried foods, coffee, spice, and meat
CPureed and blended foods to restore balance
DRaw plant-based foods only
In yin/yang balance: Yin diseases are treated with YANG foods (fried foods, coffee, spice, meat, meat broths). Yang diseases are treated with YIN foods (seaweed, many fruits and vegetables, cold beverages). Many Asian cultures believe digested food turns into yin or yang components.
Multiple Choice
Q8
A nurse is caring for a Chinese American client with hypertension. Which dietary pattern associated with Chinese cuisine places this client at greatest risk?
AHigh consumption of tofu and soy foods
BRice as a dietary staple
CUse of salt-based condiments and salting/drying to preserve foods
DHigh consumption of fruits and vegetables
The Chinese diet poses a sodium risk due to salting/drying to preserve foods and the use of salt-based condiments — placing hypertensive clients at risk. Most foods are cooked. Tofu, soy, rice, fruits, and vegetables are generally healthy components of the traditional diet.
SATA
Q9
A nurse is educating about the soul food diet. Which of the following are accurate nutrition-related health risks? (Select all that apply)
AHigh in fat, protein, and sodium
BLow in potassium, calcium, and fiber
CMany foods are fried
DHigh in whole grains and legumes
ELow in sodium due to traditional preparation methods
A, B, C are correct. Soul food is high in fat, protein, and sodium, low in potassium, calcium, and fiber (protective nutrients), and many foods are fried. Traditional soul food originated in Southern and Western Africa and is common in low-SES or rural areas.
SATA
Q10
A nurse is teaching about Mexican diet acculturation. Which of the following changes occur as clients acculturate to American culture? (Select all that apply)
ACorn-based products replaced with flour-based products
BRed meat intake increases while legume intake decreases
CIncreased use of fats such as butter, margarine, and salad dressing
DFruit juice replaced with high-sugar carbonated sodas
EDecreased intake of vegetables
All five are correct Mexican acculturation changes. Also: milk intake increases or is replaced with low-fat options. Traditional Mexican diet includes rice, corn, tortillas, tropical fruits, vegetables, nuts, legumes, eggs, cheese, seafood, and poultry — with infrequent sweets and red meat.
Multiple Choice
Q11
A nurse educator asks a newly hired nurse about Orthodox Judaism dietary laws. Which statement by the nurse indicates correct understanding?
A"Most Orthodox Jews do not drink caffeinated beverages."
B"Most Orthodox Jews do not eat meat and dairy products at the same meal."
C"Most Orthodox Jews avoid all animal products."
D"Most Orthodox Jews fast every Friday."
Orthodox Judaism prohibits eating meat and dairy at the same meal. Pareve foods contain neither and can be eaten at any time. Kosher animals must be ritually slaughtered. Only fish with scales and fins are permitted. Yom Kippur = 24-hr fast. No caffeine restriction applies to Judaism (that is Seventh-Day Adventism and Mormonism).
SATA
Q12
A nurse is reviewing dietary laws for clients practicing Islam. Which of the following are correct? (Select all that apply)
AMeat cannot be eaten with dairy products
BPork and pork products are prohibited
CFasting is required during Ramadan
DBeef is prohibited
EAlcohol is prohibited
FAnimals must be ritually slaughtered (Halal)
B, C, E, F are correct for Islam. Meat/dairy separation is an Orthodox Judaism rule (not Islam). Beef is NOT prohibited in Islam — it is Hinduism that prohibits beef. Islam: foods are Halal (permitted) or Haram (prohibited) per the Qur'an.
SATA
Q13
A nurse is caring for a client who practices Seventh-Day Adventism. Which dietary restrictions should the nurse anticipate? (Select all that apply)
ANo alcohol
BNo coffee or tea
CVegetarian diet recommended
DNo pork
ENo beef
A, B, C, D are correct for Seventh-Day Adventism. Beef is NOT specifically prohibited (that is Hinduism). Seventh-Day Adventism also recommends 5–6 hr intervals between meals. They share no pork and no alcohol with Islam, Hinduism, and Mormonism.
Multiple Choice
Q14
A Roman Catholic client is admitted during Lent. Which dietary practice should the nurse anticipate on Fridays?
AComplete fasting from all food and beverage
BRefraining from eating meat
CEating only pureed foods
DFasting for 24 hours
Roman Catholicism calls for refraining from meat on Ash Wednesday and all Fridays during Lent, and avoiding food or beverage for 1 hr before communion. Judaism calls for a 24-hr fast on Yom Kippur. Islam fasts during Ramadan.
Multiple Choice
Q15
A vegan client is at risk for deficiency in which nutrients due to consuming only plant-based foods?
Vegan diets carry risk of deficiency in: Vitamin B12 (found only in animal-origin foods), iron, calcium, zinc, Vitamin D, and omega-3 fatty acids. Protein is adequate with sufficient nuts and legumes. Fiber, phytochemicals, Vitamin C, folate, and potassium are typically HIGH in plant-based diets.
SATA
Q16
A nurse is providing culturally competent nutritional counseling. Which of the following are appropriate nursing interventions? (Select all that apply)
AAsk the client to reduce (not eliminate) culturally significant foods that are medically negative
BSuggest fruits and vegetables similar in taste or texture to what the client prefers
CConsult a dietitian to combine medical recommendations with personal preferences
DAsk questions about what the client considers healthy versus unhealthy
EInstruct the client to completely eliminate all traditional foods that conflict with the medical plan
A, B, C, D are correct. Nurses should ask clients to REDUCE (not eliminate) problematic cultural foods — reducing portion size or eating less often. Complete elimination is culturally insensitive and less likely to be followed. Always consult the dietitian and explore client values around food.
Fill in the Blank
Q17
The ___________ is the largest minority group in the U.S., with the largest percentage of clients being of Mexican heritage.
✅ Correct! Hispanic/Latinx is the predominant minority group in the U.S. Black/African American is the 2nd largest, and Asian American/Pacific Islander is the 3rd largest (with 37 different ethnic groups).
Multiple Choice
Q18
A nurse is assessing a first-generation immigrant client versus their second-generation children. Which statement about acculturation is most accurate?
AFirst-generation members adopt the dominant culture faster than subsequent generations
BAcculturation only affects food choices, not other cultural practices
CFirst-generation members are more likely to follow traditional foodways; subsequent generations incorporate dominant culture practices through socialization
DAcculturation always improves nutritional health outcomes
First-generation members more closely follow traditional foodways. Subsequent generations incorporate dominant culture food practices through socialization. Acculturation can be positive (adding healthier foods) or NEGATIVE (increasing high-fat, high-calorie, high-sodium foods).
Multiple Choice
Q19
A macrobiotic diet is best described as which of the following?
AA diet consisting entirely of uncooked plant-based foods
BA strict vegan diet with no animal products of any kind
CA whole-foods diet based on locally grown plants with occasional fish or seafood
DA diet that includes dairy and eggs but no meat or poultry
A macrobiotic diet is a whole-foods diet based on locally grown plants with occasional fish or seafood. It differs from raw vegan (uncooked only) and strict vegan (no animal products at all). It carries nutritional risk for deficiency in B12, Vitamin D, iron, calcium, and zinc if not carefully planned.
SATA
Q20
A nurse is reviewing dietary laws followed by those practicing Orthodox Judaism. Which of the following are correct? (Select all that apply)
AMeat cannot be eaten with dairy products (pareve foods contain neither)
BPork and pork products are prohibited
C24-hour fast during Yom Kippur
DBeef is prohibited
EAlcohol is prohibited
FRitual slaughter of animals (Kosher)
A, B, C, F are correct for Orthodox Judaism. Beef is NOT prohibited in Judaism (it is Hinduism that restricts beef). Alcohol is NOT prohibited in Judaism (it is Islam, Hinduism, Mormonism, and Seventh-Day Adventism). Orthodox Judaism also requires that fish have scales and fins, and prohibits food preparation on the Sabbath.
Multiple Choice
Q21
During Passover, a client who practices Judaism would be expected to consume only which type of bread?
AUnleavened bread only
BWhole grain bread only
CNo bread of any kind
DAny bread is acceptable during Passover
During Passover, Judaism calls for consumption of UNLEAVENED bread only. Some religions observe feasts on specific days (Eastern Orthodox Christian, Judaism). The nurse should ask clients about specific dietary practices related to religious holidays, as these may affect hospital meal planning.
Multiple Choice
Q22
A nurse is caring for a Hindu client in the hospital. Which dietary restriction should the nurse most anticipate?
ANo pork or pork products
BNo coffee or tea
CNo beef and possibly vegetarian diet due to ahimsa (non-harm to living creatures)
DNo eating meat with dairy at the same meal
Hinduism prohibits beef and values ahimsa (non-harm to living creatures), leading many followers to practice vegetarianism. Hinduism also restricts pork and alcohol. No coffee/tea = Seventh-Day Adventism and Mormonism. No meat with dairy = Orthodox Judaism.
Fill in the Blank
Q23
In Islam, foods are classified as either permitted (___________ ) or prohibited (___________ ). (Enter as: halal/haram)
✅ Correct! In Islam, foods are either Halal (permitted) or Haram (prohibited) per the Qur'an. Islamic dietary laws include: no pork, no alcohol, ritual slaughter of animals (Halal), and fasting during Ramadan.
SATA
Q24
A nurse is assessing a new client's dietary preferences. Which questions should the nurse ask to determine cultural and religious influences on diet? (Select all that apply)
A"What do food and eating mean to you?"
B"Do you abstain from any foods?"
C"Are there restrictions related to food preparation?"
D"Who shops for and prepares your food?"
E"Do your beliefs dictate fasting, feasting, or specific foods on certain days?"
All five are correct culturally sensitive nutritional assessment questions. The nurse should focus on the individual client's needs rather than making assumptions based on cultural background. Also ask about what the client considers healthy vs. unhealthy, when they eat meals, and whether foods are linked to spiritual beliefs.
Multiple Choice
Q25
Which cultural group has the LOWEST prevalence of obesity and the HIGHEST life expectancy (specifically for females)?
AHispanic/Latinx
BBlack/African American
CAsian American/Pacific Islander
DWhite/non-Hispanic
Asian American/Pacific Islander clients have the LOWEST obesity prevalence and the HIGHEST life expectancy (Asian American females). However, they have a HIGHER risk of Type 2 DM when body fat increases compared to other groups — meaning they can develop diabetes at lower BMI values.
Chapter 7 — Nutrition Across the Lifespan | 0 / 0 answered |
Multiple Choice
Q1
A pregnant client asks how much additional folic acid she needs. The nurse explains that folic acid is critical in early pregnancy primarily to prevent which complication?
AGestational diabetes
BPreeclampsia
CNeural tube defects
DIron-deficiency anemia
Folic acid (synthetic form of folate) prevents neural tube defects (spina bifida, anencephaly). Neural tube formation occurs very early in gestation — often before the client knows she is pregnant. All clients of childbearing age should consume adequate folate.
SATA
Q2
A nurse is teaching a pregnant client about increased nutrient needs. Which of the following nutrients have increased requirements during pregnancy? (Select all that apply)
AFolic acid
BIron
CCalcium
DProtein
EIodine
All five have increased requirements during pregnancy. Pregnancy also increases needs for Vitamin D, zinc, and overall caloric intake. Iron is needed for increased blood volume and fetal development. Iodine is critical for fetal brain development.
Multiple Choice
Q3
A lactating client asks if breastfeeding affects her caloric needs. The nurse should explain that lactation requires approximately how many additional calories per day?
A100–200 additional calories
B300–500 additional calories
C600–700 additional calories
DNo additional calories are needed
Lactation requires approximately 300–500 additional calories per day above pre-pregnancy intake. Adequate fluid intake is also essential for milk production. Nutrient needs remain elevated during lactation, similar to pregnancy.
Multiple Choice
Q4
A nurse is teaching parents about introducing solid foods to an infant. According to the 2020–2025 Dietary Guidelines, at what age should nutrient-dense complementary foods be introduced?
A3 months
B4 months
CAbout 6 months
D9–12 months
At about 6 months, introduce nutrient-dense complementary foods including a variety of foods from all food groups. For the first ~6 months: exclusively human milk or iron-fortified infant formula + supplemental Vitamin D soon after birth.
SATA
Q5
A nurse is teaching parents about infant nutrition. Which of the following are correct? (Select all that apply)
AVitamin D supplementation should begin soon after birth for breastfed infants
BHoney is safe to add to formula to improve sweetness
CIron-fortified infant formula is appropriate when human milk is unavailable
DAdded sugars should be avoided entirely for children under age 2
ECow's milk can safely replace breast milk or formula at 3 months
A, C, D are correct. Honey should NEVER be given to infants under 1 year due to risk of botulism. Cow's milk should not replace breast milk or formula before 12 months — it lacks the right nutrient profile for infants. Added sugars must be avoided entirely for those under age 2.
Multiple Choice
Q6
A nurse is assessing a toddler's nutritional intake. Which of the following is a common nutritional concern for toddlers?
AIron-deficiency anemia due to excessive milk intake displacing iron-rich foods
BExcessive protein intake from complementary foods
CVitamin D toxicity from fortified foods
DHypercalcemia from too much dairy
Iron-deficiency anemia is a key concern for toddlers — especially when excessive milk intake (>24 oz/day) displaces iron-rich solid foods. Toddlers, older infants, and menstruating/pregnant clients are all at risk for iron deficiency anemia.
Multiple Choice
Q7
A school-age child is brought in for a well-child visit. The nurse notes the child's BMI is at the 87th percentile. Which nutritional guidance is most appropriate?
APlace the child on a strict calorie-restricted diet immediately
CRecommend eliminating all carbohydrates from the child's diet
DAdvise the parents that a BMI at the 87th percentile is within normal range
For overweight children, emphasis should be on healthy eating patterns and increased physical activity — not strict calorie restriction, which can interfere with growth. The 85th–94th percentile is considered overweight for children; ≥95th is obese.
SATA
Q8
A nurse is teaching an adolescent client about nutritional needs during puberty. Which of the following are correct? (Select all that apply)
ACalcium needs are high due to rapid bone growth
BIron needs increase, especially for females who begin menstruating
CCaloric needs increase significantly during the growth spurt
DAdolescents are at risk for eating disorders and poor nutritional habits
EProtein needs decrease during adolescence compared to childhood
A, B, C, D are correct. Protein needs actually INCREASE during adolescence due to the rapid growth spurt (E is wrong). Calcium is critical for peak bone mass development. Iron needs rise especially for females beginning menstruation. Adolescence is the highest-risk period for development of eating disorders.
Multiple Choice
Q9
An older adult client tells the nurse they are not hungry and rarely eat. Which age-related change best explains decreased appetite in older adults?
AIncreased metabolism requiring less food intake
BIncreased production of digestive enzymes
CIncreased sense of smell and taste enhancing food enjoyment
DDecreased sense of smell and taste, reduced gastric motility, and physiological changes reducing appetite
Older adults experience decreased sense of smell and taste, reduced gastric motility, decreased saliva production, and other physiological changes that reduce appetite. Social isolation, partner loss, fixed income, medications, and dementia also contribute to poor nutrition in older adults.
SATA
Q10
A nurse is assessing nutritional risk factors specific to older adults. Which of the following are correct? (Select all that apply)
ADementia can make shopping, storing, and cooking food difficult
BSocial isolation and partner loss can lead to poor nutrition
CFixed income can cause difficulty purchasing adequate food
DMedications can cause electrolyte losses
EVitamins and minerals may be needed in increased amounts
All five are correct. Community resources like senior centers, food programs, food banks, and Meals on Wheels (for housebound clients) should be recommended. The nurse should also refer clients to these programs when appropriate.
Multiple Choice
Q11
A nurse is advising an older adult about fluid intake. The classic "8×8" guideline (64 oz/day) is described as:
AA strict requirement for all older adults regardless of health status
BA general guideline — solid foods also provide water, and normal eating/drinking habits generally provide sufficient fluids for healthy adults
CAn outdated recommendation; older adults should limit fluid to 32 oz/day
DA minimum that must be exceeded significantly for older adults
The "8×8" (64 oz/day) is a guideline — solid foods also provide water. For healthy adults, normal eating and drinking habits generally provide sufficient fluids. Encourage water and natural juices; discourage soda and caffeinated drinks as primary fluids.
Fill in the Blank
Q12
According to the 2020–2025 Dietary Guidelines, added sugars should be avoided entirely for children younger than age ___.
✅ Correct! For children younger than age 2, added sugars should be AVOIDED entirely. Starting at age 2, added sugars should be limited to less than 10% of calories per day.
Multiple Choice
Q13
A pregnant client is concerned about weight gain. The nurse teaches that inadequate weight gain during pregnancy is associated with which risk?
ALow birth weight and preterm birth
BGestational diabetes
CMacrosomia (large for gestational age infant)
DIncreased risk for postpartum hemorrhage
Inadequate weight gain during pregnancy is associated with low birth weight and preterm birth. Excessive weight gain is associated with macrosomia, gestational diabetes, and increased cesarean delivery risk. Adequate nutrition supports both maternal and fetal health.
SATA
Q14
A nurse is teaching parents about childhood nutritional concerns. Which of the following are correct? (Select all that apply)
ABreakfast is the most important meal for school-age children's cognitive performance
BChildhood obesity increases the risk of cardiovascular disease and type 2 diabetes in adulthood
CChildren need adequate calcium and Vitamin D for bone development
DScreen time and sedentary behavior are associated with childhood obesity
EChildren under 5 years require less protein per kilogram than adults
A, B, C, D are correct. Children actually require MORE protein per kilogram of body weight than adults due to growth and development needs (E is wrong). Calcium and Vitamin D are critical during childhood for building peak bone mass.
Multiple Choice
Q15
A nurse is teaching an older adult about protein intake. Which statement is most accurate?
AOlder adults need less protein than younger adults because metabolism slows
BProtein should make up no more than 10% of total calories in older adults
CUp to 35% of daily calories can come from fat, and at least 45% should come from carbohydrates for older adults
DOlder adults should eliminate red meat entirely to reduce cardiovascular risk
For older adults: up to 35% of daily calories from fat and at least 45% from carbohydrates are appropriate. The need for vitamins and minerals can actually INCREASE with age. Older adults may need more protein than the standard 0.8 g/kg due to decreased absorption efficiency and muscle loss.
Fill in the Blank
Q16
A housebound older adult who has difficulty preparing meals should be referred to which community program?
✅ Correct! Meals on Wheels is the program specifically for housebound older adults. Other resources include senior centers, community programs, food programs, and food banks for those with fixed income or food insecurity.
Multiple Choice
Q17
A nurse is caring for an older adult taking multiple medications. Which of the following nutritional effects of medications should the nurse monitor for?
AIncreased appetite and weight gain in most older adults on medications
BMedications rarely affect electrolyte balance in older adults
CVitamin toxicity from medication-food synergy
DElectrolyte losses and potential drug-nutrient interactions affecting nutritional status
Medications can cause electrolyte losses and drug-nutrient interactions in older adults. This is a key nursing concern. The interprofessional team (nurse, dietitian, pharmacist, provider) should monitor weight, electrolytes, and overall physical condition, especially for older adults on multiple medications.
SATA
Q18
A nurse is reviewing the 2020–2025 Dietary Guidelines as they relate to pregnancy. Which of the following are correct? (Select all that apply)
AAdequate folic acid before and during pregnancy prevents neural tube defects
BIodine is important for fetal brain development during pregnancy
CMyPlate resources are available specifically for women during pregnancy and lactation
DPregnant clients should eliminate all fat from their diet to prevent excessive weight gain
EProtein needs decrease during pregnancy to protect fetal kidneys
A, B, C are correct. Fat should NOT be eliminated during pregnancy — fat is essential for fetal brain development and fat-soluble vitamin absorption. Protein needs INCREASE during pregnancy, not decrease. The MyPlate website offers specific resources for pregnant and lactating women.
Multiple Choice
Q19
A nurse is teaching a parent about feeding a toddler ages 12–23 months who is no longer receiving human milk or infant formula. Which guidance aligns with the 2020–2025 Dietary Guidelines?
ABegin a low-fat diet to prevent early childhood obesity
BFollow a healthy dietary pattern that meets nutrient needs, achieves healthy body weight, and reduces chronic disease risk
CIntroduce high-sugar foods gradually to develop tolerance
DRestrict all dairy products until age 2
From 12 months through older adulthood: follow a healthy dietary pattern that meets nutrient needs, achieves healthy body weight, and reduces chronic disease risk. Low-fat diets are NOT appropriate for toddlers — children need adequate fat for brain development. Added sugars should be AVOIDED for under age 2.
Multiple Choice
Q20
A nurse is reviewing the Dietary Guidelines regarding alcohol consumption. Which statement is correct?
AModerate alcohol intake has proven health benefits and is encouraged
BMen can safely consume up to 4 drinks per day
CWomen can safely consume up to 2 drinks per day
DDrinking less is better for health; if drinking, limit to ≤2 drinks/day for men and ≤1 drink/day for women
The 2020–2025 Dietary Guidelines state: "drinking less is better for health." If choosing to drink, limit intake to 2 drinks or less per day for men and 1 drink or less per day for women. Alcohol consumption is not encouraged for its health benefits in these guidelines.
Fill in the Blank
Q21
An infant receiving gavage (tube) feeding has a flexible feeding tube that can remain taped in place for up to ___ days.
✅ Correct! For infant gavage feeding, a flexible tube is inserted from the nares or mouth into the stomach and can remain taped in place for up to 30 days. Gavage feeding is used when an infant is too weak to suck, cannot coordinate swallowing, lacks a gag reflex, or becomes fatigued/cyanotic during feeding.
SATA
Q22
A nurse is teaching an older adult client about nutrition. Which of the following are appropriate recommendations for older adults? (Select all that apply)
AEncourage water and natural juices as primary fluid sources
BDiscourage soda and caffeinated drinks as primary fluids
CRefer housebound clients to Meals on Wheels
DRefer clients with fixed incomes to food banks and community food programs
ERecommend complete bed rest to conserve energy and nutritional reserves
A, B, C, D are correct. Complete bed rest is NOT recommended — physical activity is important for maintaining muscle mass, bone density, and overall health in older adults. Community resources (senior centers, Meals on Wheels, food banks, food programs) should be recommended as appropriate.
Multiple Choice
Q23
A nurse is teaching about the 4 overarching Dietary Guidelines. Which guideline focuses on personal preferences, cultural traditions, and budgetary considerations?
AGuideline 1: Follow a healthy dietary pattern at every stage of life
BGuideline 2: Customize and enjoy nutrient-dense food and beverage choices
CGuideline 3: Focus on meeting food group needs with nutrient-dense foods
DGuideline 4: Limit foods high in added sugars, saturated fat, and sodium
Guideline 2 = Customize and enjoy nutrient-dense food and beverage choices to reflect personal preferences, cultural traditions, and budgetary considerations. The framework is designed for individualization. Guideline 1 = every life stage. Guideline 3 = food groups + calorie limits. Guideline 4 = limit harmful substances.
Chapter 8 — Modified Diets | 0 / 0 answered |
Multiple Choice
Q1
A nurse explains that therapeutic nutrition refers to which of the following?
AA diet prescribed only for clients with cancer or renal disease
BVitamin and mineral supplementation for hospitalized clients
CThe role of food and nutrition in the treatment of diseases and disorders, modifying the basic diet to meet client needs
DEnteral or parenteral nutrition for clients who cannot eat
Therapeutic nutrition = the role of food and nutrition in the treatment of diseases and disorders. The basic diet becomes therapeutic when modifications are made. Modifications include changing calories, fiber, specific nutrients, food consistency, or omitting specific foods. Food meets both physiological AND psychological needs.
Multiple Choice
Q2
A nurse is caring for a client following an appendectomy with a prescription to "advance diet to clear liquids as tolerated." Which of the following should the nurse offer?
AApplesauce and wheat toast
BSherbet and scrambled eggs
CPureed carrots and broth
DChicken broth and cranberry juice
Clear liquids include: water, tea, coffee, fat-free broth, carbonated beverages, clear juices, ginger ale, and gelatin. Applesauce, toast, sherbet, eggs, and pureed foods are NOT clear liquids. Clear liquid diet is nutritionally inadequate and should not be used long-term.
SATA
Q3
A nurse is teaching about the clear liquid diet. Which statements are correct? (Select all that apply)
APrimarily prevents dehydration and relieves thirst
BRequires minimal digestion, leaves minimal residue, and is non-gas-forming
CNutritionally inadequate and should not be used long-term
DIncludes plain ice cream and strained cereals
EIndicated for acute illness, pre-procedure colon prep, and some postoperative recovery
A, B, C, E are correct. Plain ice cream and strained cereals are part of the FULL LIQUID diet, not clear liquid. Clear liquid = water, tea, coffee, fat-free broth, carbonated beverages, clear juices, ginger ale, gelatin only.
Multiple Choice
Q4
A client is transitioning from a full liquid to a soft diet. The nurse understands that if a full liquid diet is used for more than 3 days, which intervention may be needed?
ASwitch immediately to a regular diet
BSupplementation of protein and calories may be required
CAdd fiber supplements to prevent constipation
DNo intervention needed — full liquid diet is nutritionally complete
Full liquid diet may require supplementation of protein and calories if used for more than 3 days. It offers more variety than clear liquid but is still not fully adequate long-term. Also use cautiously with dysphagia clients unless liquids are thickened appropriately.
SATA
Q5
A nurse is planning a blenderized (pureed) diet for a client. Which of the following clients is this diet appropriate for? (Select all that apply)
AA client with a wired jaw following a motor vehicle crash
BA client 24 hours post-op from temporomandibular joint repair
CA client with difficulty chewing due to oral surgery
DA client with hypercholesterolemia due to coronary artery disease
EA client scheduled for a colonoscopy in the morning
A, B, C are correct — all involve chewing or swallowing difficulties, oral/facial surgery, or wired jaws. The hypercholesterolemia client needs a cardiac/low-fat diet (not pureed). The pre-colonoscopy client needs a clear liquid diet.
Multiple Choice
Q6
A nurse is aware that the soft (bland) diet predisposes clients to which complication?
AConstipation
BDiarrhea
CDumping syndrome
DAspiration
The soft/bland diet is low in fiber and excludes raw fruits, vegetables, coarse breads, cereals, and gas-forming foods — this predisposes clients to constipation. The nurse should monitor bowel patterns and ensure adequate fluid intake.
SATA
Q7
A nurse is assisting a client on a mechanical soft diet with food selections. Which selections are appropriate? (Select all that apply)
ADried prunes
BGround turkey
CMashed carrots
DFresh strawberries
ECottage cheese
B, C, E are correct. Mechanical soft diet includes: ground meats, canned fruits, softly cooked vegetables, mashed items, cottage cheese. EXCLUDES: dried fruits (chewy), most raw fruits and vegetables, foods with seeds and nuts. Dried prunes = hard/chewy. Fresh strawberries = seeds.
Multiple Choice
Q8
A nurse is caring for a client with a mechanical soft diet prescription. Which conditions are indications for this diet? (Select the best answer)
AAcute gastritis and febrile conditions
BPre-colonoscopy preparation
CAcute illness and dehydration prevention
DDysphagia, poorly fitting dentures, edentulous clients, and head/neck surgery
Mechanical soft diet indications: limited chewing ability, dysphagia, poorly fitting dentures, edentulous (no teeth) clients, surgery to head/neck/mouth, and intestinal strictures. Acute gastritis/febrile = full liquid diet. Pre-colonoscopy = clear liquid. Acute illness/dehydration = clear liquid.
Multiple Choice
Q9
A client following a stroke is prescribed a Level 5 dysphagia diet (Minced and Moist). Which food selection is most appropriate?
ATurkey sandwich on whole wheat bread
BScrambled eggs
CPeanut butter crackers
DGranola with milk
Level 5 (Minced and Moist) = soft, visible lumps, easy to mash with tongue, consumed with fork or spoon. Scrambled eggs are soft, moist, and easy to mash — perfect for Level 5. Turkey sandwich = mixed textures/too firm. Peanut butter = sticky. Granola = hard and crunchy.
SATA
Q10
A nurse is reviewing the IDDSI dysphagia liquid levels with a student. Which of the following correctly match the level to its description? (Select all that apply)
ALevel 0 (Thin) — flows like water; can be consumed by cup or straw
BLevel 2 (Mildly Thick) — does not hold shape when poured; spoon ok, straw requires considerable effort
CLevel 3 (Moderately Thick) — smooth, no lumps; consumed from cup or spoon but NOT a fork
DLevel 4 (Extremely Thick) — holds shape; eaten with spoon only; not sticky; no chewing needed
ELevel 1 (Slightly Thick) — thicker than water but cannot be consumed through a straw
A, B, C, D are correct. Level 1 (Slightly Thick) CAN be sipped through a straw — it is thin enough for a straw but thicker than water. That makes E incorrect. Remember: Level 3 = cannot use a fork. Level 4 = spoon only, holds its shape.
Fill in the Blank
Q11
The dysphagia diet Level 6 is described as ___________ and ___________ foods that are easily chewed and swallowed. (Enter as: soft/bite-sized)
✅ Correct! Level 6 (Soft and Bite-Sized) = soft-textured, moist, semi-solid foods that are easily chewed and swallowed. Level 7 = Easy to Chew (near-normal, moist, hard/sticky foods eliminated) OR Regular (normal everyday foods).
Multiple Choice
Q12
A nurse is advancing a post-surgical client's diet. Before advancing the diet, the nurse should first assess for which of the following?
APain level less than 3/10
BNormal blood glucose levels
CReturn of bowel function — bowel sounds and passage of flatus
DAbility to ambulate independently
Before advancing a post-surgical diet, the nurse must assess for return of bowel function: auscultation of bowel sounds AND passage of flatus. Dietary intake is progressively increased: NPO → clear liquids → full liquids → soft → regular following major surgery.
Multiple Choice
Q13
When a client is prescribed "diet as tolerated," the nurse should assess which factors before selecting the most appropriate diet?
AMost recent lab values and BMI
BFamily preferences and cultural background only
CActivity level and pain tolerance
DHunger, appetite, and nausea; consult with dietitian
For a "diet as tolerated" prescription, the nurse should assess hunger, appetite, and nausea to determine the most appropriate diet, and consult with a dietitian. The prescription permits client preferences while taking into consideration the client's ability to eat.
SATA
Q14
A nurse is teaching about manifestations of dysphagia. Which of the following are signs of dysphagia? (Select all that apply)
ADrooling
BPocketing food in the cheeks
CChoking or gagging during eating
DCoughing after swallowing
EIncreased appetite and rapid eating
A, B, C, D are correct manifestations of dysphagia. The IDDSI defines dysphagia as impaired swallowing (e.g., following a stroke). Signs include drooling, pocketing food, choking, and gagging. Increased appetite is not a sign of dysphagia.
Fill in the Blank
Q15
To add calories to a pureed diet, the nurse can suggest adding broth, milk, gravy, cream, or fruit juice to foods instead of ___________.
✅ Correct! Adding broth, milk, gravy, cream, soup, tomato sauce, or fruit juice INSTEAD OF water provides additional calories and nutritional value to pureed foods. Also: each food is pureed separately to preserve individual flavor.
Multiple Choice
Q16
A nurse is comparing the soft diet to the mechanical soft diet. Which of the following correctly differentiates the two?
AThe soft diet includes ground meats and canned fruits; the mechanical soft requires only liquids
BThe soft diet is low in fiber and lightly seasoned; the mechanical soft is a regular diet modified in texture requiring minimal chewing
CThe mechanical soft diet is nutritionally inadequate and requires supplementation
DBoth diets are identical and can be used interchangeably
Soft diet = whole foods, low fiber, lightly seasoned, easily digested; excludes raw fruits/veggies, coarse grains, gas-forming foods; predisposes to constipation. Mechanical soft = regular diet modified in TEXTURE; includes ground meats, canned fruits, softly cooked veggies; requires minimal chewing before swallowing.
Multiple Choice
Q17
A nurse documents ongoing nutritional assessment for a client on a modified diet. Which parameters should be included in ongoing assessment?
AWeekly weights and monthly lab values
BBMI only
CDaily calorie counting and 24-hr recall only
DDaily weights, prescribed lab tests, evaluation of nutritional and energy needs, and response to diet therapy
Ongoing nutritional assessment parameters include: daily weights, prescribed laboratory tests, evaluation of nutritional and energy needs, and response to diet therapy. The nurse should also observe and document nutritional intake and perform a calorie count if needed.
Multiple Choice
Q18
A nurse is caring for a client with dysphagia. Which IDDSI level describes liquids that flow like water and can be consumed through a cup or straw?
ALevel 0 — Thin
BLevel 1 — Slightly Thick
CLevel 2 — Mildly Thick
DLevel 3 — Moderately Thick
Level 0 (Thin) = flows like water; can be consumed through cup or straw, age appropriate. Level 1 = slightly thicker than water, still flows through straw. Level 2 = thickened, does not maintain shape, straw requires effort. Level 3 = smooth, no lumps, cup or spoon only (NOT fork).
SATA
Q19
A nurse is reviewing which clients require a modified diet versus a regular diet. Which clients should receive a regular (house) diet? (Select all that apply)
AA client admitted for an elective knee replacement with no dietary restrictions
BA client with dysphagia following a stroke
CA client who prefers a vegetarian diet but has no medical restrictions
DA client with wired jaws following a motor vehicle crash
EA client with inflammatory bowel disease requiring low-residue foods
A and C are correct — both have no medical dietary restrictions. Regular diet = no restrictions, adjusted for age-specific needs and personal preferences/culture. Dysphagia → dysphagia diet. Wired jaws → pureed diet. IBD requiring low-residue → soft/modified diet.
Multiple Choice
Q20
The full liquid diet is used cautiously for clients with dysphagia unless which modification is made?
ALiquids are served chilled to slow swallowing
BLiquids are served in small amounts only
CLiquids are thickened appropriately to match the client's dysphagia level
DLiquids are replaced with pureed solids
Full liquid diet is used cautiously with dysphagia clients UNLESS liquids are thickened appropriately to match the prescribed IDDSI dysphagia level. Thin liquids pose an aspiration risk for dysphagia clients. Many dietary manuals have removed the full liquid diet from routine use.
Fill in the Blank
Q21
In a pureed diet, each food is pureed ___________ to preserve individual flavor.
✅ Correct! Each food is pureed SEPARATELY to preserve individual flavor. The composition and consistency of the pureed diet varies depending on the client's needs. Calories can be boosted by adding broth, milk, gravy, cream, soup, tomato sauce, or fruit juice instead of water.
SATA
Q22
A nurse is reviewing the mechanical soft diet with a student. Which foods should be EXCLUDED from a mechanical soft diet? (Select all that apply)
ADried fruits
BFoods containing nuts and seeds
CMost raw fruits and vegetables
DGround meats
ECanned fruits
A, B, C are excluded from mechanical soft diet. Ground meats (D) and canned fruits (E) are appropriate — they require minimal chewing. Butter, gravies, sugar, or honey can be ADDED to increase caloric intake. Softly cooked vegetables and cottage cheese are also appropriate selections.
Multiple Choice
Q23
A nurse is caring for a client on a soft diet. Which of the following food items would be EXCLUDED?
ASmooth peanut butter
BCanned peaches
CSoft-cooked oatmeal
DRaw broccoli and kidney beans
Soft diet EXCLUDES: raw fruits and vegetables, coarse breads and cereals, beans, and other gas-forming foods. Raw broccoli (raw vegetable) and kidney beans (gas-forming legume) are both excluded. The soft diet includes whole foods that are low in fiber, lightly seasoned, and easily digested.
Multiple Choice
Q24
A nurse is reviewing IDDSI solid texture levels. Which level is described as "near-normal textured foods that are moist and can include mixed consistency, with hard and sticky foods eliminated"?
ALevel 5 — Minced and Moist
BLevel 6 — Soft and Bite-Sized
CLevel 7 — Easy to Chew
DLevel 4 — Pureed
Level 7 (Easy to Chew) = near-normal textured foods, moist, can include mixed consistency; hard and sticky foods eliminated. Level 7 Regular = normal everyday foods, developmentally age appropriate. Level 6 = soft-textured, moist, semi-solid, easily chewed. Level 5 = minced and moist with visible lumps, mashed with tongue.
Chapter 9 — Enteral Nutrition | 0 / 0 answered |
Multiple Choice
Q1
Enteral nutrition (EN) is contraindicated in which of the following situations?
AClient with dysphagia following a stroke
BClient with inflammatory bowel disease
CClient with a paralytic ileus or intestinal obstruction
DClient on prolonged mechanical ventilation
EN is contraindicated when the GI tract is NONFUNCTIONAL — paralytic ileus or intestinal obstruction. EN is indicated when the GI system functions at least partially. Dysphagia, IBD, prolonged intubation, and burns are all indications FOR enteral nutrition.
SATA
Q2
A nurse is reviewing indications for enteral nutrition. Which of the following are appropriate indications? (Select all that apply)
ABurns and trauma
BNeuromuscular impairment preventing chewing or swallowing
CEating disorders
DRadiation therapy or chemotherapy
ELiver or renal dysfunction
All five are correct indications for EN. Also includes: prolonged intubation, infection, inflammatory bowel disease. Infant gavage feeding is used when an infant is too weak to suck, unable to coordinate swallowing, lacks gag reflex, or becomes fatigued/cyanotic during feeding.
Multiple Choice
Q3
A nurse is explaining nasoenteric tube types to a student. Which tube is most appropriate for a client at high risk for aspiration with delayed gastric emptying?
ANasogastric (NG) tube
BGastrostomy (PEG) tube
CJejunostomy tube
DNasoduodenal or nasojejunal tube
Nasoduodenal and nasojejunal tubes are specifically used for clients at risk for aspiration or those with delayed gastric emptying (gastroparesis) — they bypass the stomach entirely. NG tubes go only to the stomach. Ostomies (PEG, jejunostomy) are for long-term feeding.
Multiple Choice
Q4
A nurse is discussing a low-profile (skin-level) gastrostomy device with a child's guardian. Which statement is correct?
A"The device is usually more comfortable for children and is fully immersible in water."
B"Checking residual volumes is much easier with this device."
C"This device requires less maintenance than a traditional nasal tube."
D"Mobility of the child will be limited with this device."
The low-profile gastrostomy device is more comfortable, longer lasting, and fully immersible in water. However, checking for residual is MORE DIFFICULT (not easier) because the button sits close to the skin. Mobility is NOT limited.
SATA
Q5
A nurse is teaching about enteral formula selection. Which of the following are correct? (Select all that apply)
AStandard formulas are composed of whole proteins and require a functioning GI tract
BHydrolyzed formulas are used for clients with partially functioning GI tracts or impaired digestion
CHigher-calorie formulas have LOWER water content
DHydrolyzed formulas are higher in osmolality and are lactose-free
EStandard formulas are high in residue and should be avoided post-bowel surgery
A, B, C, D are correct. Standard formulas are LOW in residue (not high) — making them ideal for clients on bowel rest, post-bowel surgery, or with GI disease (E is wrong). Hydrolyzed formulas are residue-free. Fiber-enriched standard formulas are recommended for constipation or diarrhea.
Multiple Choice
Q6
Which enteral feeding delivery method is recommended for critically ill clients because it is associated with smaller residual volumes and lower risk of aspiration and diarrhea?
AContinuous infusion
BCyclic feeding
CIntermittent tube feeding
DBolus feeding
Continuous infusion = constant rate over 24 hr via pump — recommended for critically ill clients because of smaller residual volumes and lower aspiration/diarrhea risk. Cyclic = 8–20 hr (often overnight, for transitioning to oral). Intermittent = every 4–6 hr (noncritical/home/rehab). Bolus = large syringe into stomach only.
Multiple Choice
Q7
A nurse is preparing to administer bolus EN feedings. Which of the following actions is correct?
AElevate the head of the bed to 20°
BAdminister the feeding over 5 minutes
CUse a bolus feeding for a jejunostomy tube
DVerify bowel sounds, administer at room temperature, flush tube with warm water
Correct bolus technique: verify bowel sounds, administer at room temperature, flush with warm water, HOB ≥30°, give over ≥15 min (not 5 min). Bolus feedings are CONTRAINDICATED for jejunostomy or duodenal tubes — stomach only. Volume: 250–400 mL, 4–6×/day.
SATA
Q8
A nurse is teaching a client about cyclic EN feedings at home. Which instructions should the nurse include? (Select all that apply)
A"Give a feeding every 6 hours."
B"Set the feeding up before you go to bed."
C"Weigh yourself daily."
D"Flush the tube with a carbonated beverage to dislodge clogs."
E"Ensure your head is elevated to 15 degrees during administration."
B and C are correct. Cyclic feeding = continuous rate for 8–20 hr, often overnight (not every 6 hr). HOB must be ≥30° (not 15°). Carbonated beverages are NOT approved for unclogging tubes — use 30–50 mL warm water in a 60 mL piston syringe.
Fill in the Blank
Q9
Before administering the first enteral feeding, tube placement must be verified by ___________.
✅ Correct! Initial tube placement must be verified by RADIOGRAPHY (x-ray). Aspirating gastric contents and measuring pH levels are NOT considered reliable methods for verifying INITIAL placement. After verification, mark the tube with indelible ink/tape at the nose exit and measure each shift.
Multiple Choice
Q10
A nurse is caring for an adult client on continuous EN. The gastric residual volume (GRV) is 280 mL on two consecutive checks. Which action should the nurse take?
AContinue the feeding — this is within normal limits
BImmediately discontinue the feeding permanently
CFollow facility policy — GRV >250 mL on two consecutive checks indicates a need for intervention
DIncrease the infusion rate to clear residual more quickly
GRV >250 mL on TWO consecutive checks for adults indicates a need for intervention — follow facility policy. Single measurement intervention range is 100–500 mL. For children, hold if GRV >¼ of prescribed volume. Returning residual contents to the stomach prevents electrolyte/fluid imbalance but large volumes increase complication risk.
SATA
Q11
A nurse is reviewing medication administration through a feeding tube. Which of the following are correct? (Select all that apply)
AStop the feeding before administering medications
BFlush with 15–30 mL water before and after each medication
CFlush between each medication if more than one is given
DUse liquid medications when possible
EMedications can be dissolved in formula to save time
A, B, C, D are correct. Medications must ONLY be dissolved in WATER — NEVER in formula (E is wrong). Do NOT mix medications with the formula. For infants/children, flush volume = 1.5× the tube prime volume. Some suspensions may require more water to flush.
Multiple Choice
Q12
A nurse is teaching about dumping syndrome related to enteral feeding. Which manifestations should the nurse include?
ABradycardia, hypertension, and constipation
BDizziness, rapid pulse, diaphoresis, pallor, and lightheadedness
CFever, back pain, and abdominal rigidity
DBradycardia, lethargy, and hypotension
Dumping syndrome = rapid emptying of formula into small intestine → fluid shift. Manifestations: dizziness, rapid pulse, diaphoresis (sweating), pallor, and lightheadedness. It can occur with bolus feedings and is usually avoided with gastrostomy tube feedings because the stomach holds and releases feedings in a physiologic manner.
Fill in the Blank
Q13
To unclog a feeding tube, the nurse should use gentle pressure with ___ to ___ mL of warm water in a 60 mL piston syringe. (Enter as: 30-50)
✅ Correct! Use 30–50 mL warm water in a 60 mL piston syringe with GENTLE pressure to unclog a tube. Carbonated beverages are NOT approved. Commercially made products are available and effective for dissolving clotted formula. Never use forceful pressure.
Multiple Choice
Q14
A nurse is teaching about refeeding syndrome. Which client is at GREATEST risk?
AA well-nourished postoperative client started on intermittent tube feeding
BA client with mild dehydration receiving IV fluids
CA toddler transitioning from breast milk to solid foods
DA client in a starvation state who is started on enteral nutrition
Refeeding syndrome is a potentially fatal complication that occurs when a client in a STARVATION state is started on enteral nutrition. The risk is even greater with parenteral nutrition. It results from electrolyte shifts (especially phosphate) when refeeding is initiated too rapidly after prolonged starvation.
SATA
Q15
A nurse is reviewing bacterial contamination prevention for enteral feedings. Which actions should the nurse include? (Select all that apply)
AWash hands before handling formula or enteral products
BClean equipment and tops of formula cans before opening
CReplace the feeding bag, tubing, and equipment every 24 hours
DLabel open cans with client name, room number, date, and time of opening
EFill generic bags with only 4 hours worth of formula
All five are correct contamination prevention measures. Also: use closed feeding systems. Prefilled bags and administration tubing should also be discarded every 24 hr or per facility policy, even if not empty.
Multiple Choice
Q16
When can a nurse safely discontinue enteral nutrition and transition a client to oral intake?
AWhen the client requests to stop tube feeding
BWhen the client tolerates one full oral meal
CWhen the client consumes two-thirds of protein and calorie needs orally for 3 to 5 consecutive days
DWhen the client's albumin level returns to normal
EN can be discontinued when the client consumes ⅔ of protein and calorie needs orally for 3–5 consecutive days. Transition steps: stop EN 1 hr before meals → increase meal frequency → up to 6 small meals/day → when oral = 500–750 cal/day, give tube feeding only at night.
Fill in the Blank
Q17
For continuous EN infusion, the feeding tube should be flushed with at least ___ mL of water every ___ hours. (Enter as: 30/4)
✅ Correct! For continuous infusion: flush with at least 30 mL of water every 4 hours to maintain tube patency and provide hydration. Also flush after measuring GRV, before and after bolus feedings, and before/after each medication.
Multiple Choice
Q18
A nurse is managing metabolic complications of EN. Which intervention is appropriate for a client with hyperglycemia related to enteral feeding?
AIncrease the EN infusion rate to provide more calories
BSwitch to a high-calorie formula
CDiscontinue EN immediately
DAdminister insulin per prescribed protocol and monitor blood glucose
For hyperglycemia related to EN: administer insulin per prescribed protocol and monitor electrolytes, blood glucose, and weights. Also monitor respiratory, cardiovascular, and neurologic status. Consider changing to an isotonic formula and provide adequate free water for dehydration.
Multiple Choice
Q19
A nurse is educating about enteral feeding routes. Which tube type is appropriate for SHORT-TERM use only (less than 3–4 weeks)?
Nasoenteric tubes (NG, nasoduodenal, nasojejunal) are SHORT-TERM — less than 3–4 weeks. Ostomies (PEG, jejunostomy, skin-level gastrostomy) are for LONG-TERM feeding, clients at high risk for aspiration, or when nasal obstruction prevents nasal tube insertion.
SATA
Q20
A nurse is reviewing the indications for ostomy tube placement (gastrostomy/jejunostomy) over nasoenteric tubes. Which are correct indications? (Select all that apply)
ALong-term enteral feeding is required
BClient is at high risk for aspiration
CNasal obstruction makes nasal tube insertion impossible
DClient needs only 2 weeks of enteral support post-surgery
EClient has acute gastritis requiring short-term bowel rest
A, B, C are correct indications for ostomy placement. Short-term needs (2 weeks post-surgery or acute gastritis) would use nasoenteric tubes, not surgically placed ostomies. Ostomies require surgical or endoscopic placement and are appropriate when long-term access is needed.
Multiple Choice
Q21
A nurse is comparing standard and hydrolyzed enteral formulas. Which of the following is a correct distinction?
AHydrolyzed formulas require a fully functioning GI tract
CStandard formulas are higher in osmolality than hydrolyzed formulas
DHydrolyzed formulas are the first-choice for all clients starting EN
Standard (polymeric/intact) formulas = whole proteins (milk, meat, eggs) — require functioning GI tract, 1–2 cal/mL. Hydrolyzed (elemental) formulas = partially/fully broken-down nutrients — for partially functioning GI or impaired absorption (IBD, liver failure, cystic fibrosis, pancreatitis, short-gut), higher osmolality, lactose-free, residue-free.
Fill in the Blank
Q22
A generic enteral feeding bag should be filled with only ___ hours worth of formula at a time to prevent bacterial contamination.
✅ Correct! Generic bags should be filled with only 4 HOURS worth of formula. Prefilled bags and administration tubing are discarded every 24 hours or per facility policy, even if not empty. Open cans should be labeled with client name, room number, date, and time of opening.
Multiple Choice
Q23
A nurse is explaining intermittent tube feeding to a client going home. Which statement is correct about intermittent feeding?
AFormula is administered continuously over 24 hours via pump
BFormula is given in large volumes over 15 minutes using a syringe, directly into the stomach
CFormula is administered every 4–6 hours in equal portions over 30–60 minutes, resembling a normal eating pattern
DFormula is given over 8–20 hours, often overnight, to transition from EN to oral intake
Intermittent feeding = every 4–6 hr in equal portions over 30–60 min (range 20–90 min), by gravity drip or pump. Resembles normal eating pattern. Used for noncritical clients, home tube feedings, and rehabilitation clients. Option A = continuous. Option B = bolus. Option D = cyclic.
SATA
Q24
A nurse is reviewing correct nursing actions for EN preparation. Which of the following are correct? (Select all that apply)
AMark the tube at the nose exit with indelible ink or tape and document
BMeasure tube length each shift and before each feeding to check for migration
CVerify bowel sounds before initiating feeding
DAdminister formula at room temperature
EHeat formula in microwave to body temperature before administration
A, B, C, D are correct. Formula should NEVER be heated in a microwave — this causes UNEVEN temperatures within the solution which can cause burns. Start with small volume of full-strength formula and increase as tolerated. HOB must be elevated ≥30° during feeding and 30–60 min after.
Multiple Choice
Q25
A nurse is reviewing ongoing care for a client receiving enteral nutrition. Which of the following monitoring parameters are correct?
AWeekly weights only
BMonthly lab values for long-term clients
CMonitor tube site weekly for signs of infection
DDaily weights and I&O, electrolytes, BUN, creatinine, minerals, CBC, and tube site assessment
Ongoing EN monitoring includes: daily weights and I&O, electrolytes, BUN, creatinine, minerals, CBC, tube site assessment for infection (pain, redness, swelling, drainage), and frequency/character of bowel movements. GRV is checked every 4–6 hr. This comprehensive monitoring detects complications early.
SATA
Q26
A nurse is reviewing GI complications of enteral nutrition and their nursing actions. Which interventions are correct? (Select all that apply)
AConsider a change in formula if GI complications persist
BDecrease the flow rate or total volume of infusion
CIncrease the volume of free water if the client is constipated
DAdminister the EN at room temperature
ETake measures to prevent bacterial contamination
All five are correct nursing actions for GI complications (constipation, diarrhea, cramping, distention, dumping syndrome, N&V). GI complications are the most common type. Dumping syndrome = rapid gastric emptying → dizziness, rapid pulse, diaphoresis, pallor, lightheadedness.
📋
Nutrition Across the Lifespan
2020–2025 Dietary Guidelines for Americans
Guideline 1
Healthy Pattern
Follow a healthy dietary pattern at every stage of life
Guideline 2
Customize
Enjoy nutrient-dense choices that reflect personal, cultural & budget needs
Guideline 3
Nutrient-Dense
Meet food group needs; stay within calorie limits
Guideline 4
Limit
Limit added sugars, saturated fat, sodium, and alcohol
✅ Focus ON
Fiber-rich fruits & vegetables
Whole grains
Low-fat/fat-free milk & dairy
Lean meats, poultry, fish, legumes, eggs, nuts
⚠️ LIMIT
Added sugars: <10% cal/day (age 2+)
Saturated fat: <10% cal/day
Sodium: <2,300 mg/day (~1 tsp)
Alcohol: ≤2 drinks/day men, ≤1 drink/day women
🤰
Pregnancy & Lactation
⚡ Key Pre-Pregnancy Facts
Pre-pregnancy matters! Early fetal development occurs before a client knows they're pregnant. Normal weight + adequate folate BEFORE conception is critical.
⚠️Low folate before conception increases risk of neural tube defects
Avoid: hot dogs, popcorn, peanuts, grapes, raw carrots, celery, peanut butter, tough meat, candy
Always adult supervision during meals
Cut small bite-sized pieces
No eating during play or lying down
🩸Iron deficiency anemia = most common nutritional deficiency in children. Limit milk to 24 oz/day (poor iron source, displaces iron-rich foods). Vitamin C with plant iron sources maximizes absorption.
☀️ Preschoolers (3–6 years)
Growth: 2–3 inches/year, 5–6 lb/year. Protein needs: 13–19 g/day
Can switch to skim or 1% low-fat milk after age 2
Food jags (fixation on one food) are common and short-lived
Dislike strong-tasting veggies (cabbage, onions); like raw finger-food vegetables
Food preferences first learned from family; peers start influencing at ~age 5
Children indoors (TV/video games) have ↑ risk of deficiency
Assists calcium absorption into bones
📝 NCLEX Practice
A nurse is educating parents of a toddler about appropriate snack foods. Which should the nurse include? (Select all that apply)
A Graham crackers ✓
B Apple slices ✓
C Raisins (choking hazard)
D Jellybeans (choking hazard)
E Cheese cubes ✓
🧑
Adolescence
📈Growth rate during adolescence is second only to infancy. Needs for energy, protein, calcium, iron, and zinc all increase at puberty.
📅 Growth Spurts
👩 Female
Begins: 10–11 years
Peaks: 12 years
Completes: 17 years
Less muscle/bone growth; more fat deposition → lower energy needs than males
👨 Male
Begins: 12–13 years
Peaks: 14 years
Completes: 21 years
More muscle/bone growth → higher energy needs
⚡ Energy Requirements
Females (12–18 yr)
~2,000 cal/day
Males (12–18 yr)
2,200–2,800 cal/day
🩸 Iron Requirements
👩 Females (14–18 yr)
15 mg/day
Support ↑ blood volume + menstrual losses
👨 Males (14–18 yr)
11 mg/day
Support muscle mass + blood volume expansion
🦴 Calcium
Adolescents add 45% of bone mass during this period. Inadequate calcium → risk of osteoporosis later in life.
Requirement: 1,300 mg/day
Achieved by 3–4 servings dairy/day
Normal blood calcium maintained by drawing from bones if intake is low
⚠️ Nutritional Risks
⚠️Average U.S. adolescent diet is deficient in: folate, vitamins A & E, iron, zinc, magnesium, calcium, and fiber (more pronounced in females). Diet EXCEEDS: total fat, saturated fat, cholesterol, sodium, sugar.
Skip meals, especially breakfast; eat more away from home
Vending machines, fast food = high fat, sugar, sodium
Carbonated beverages replacing milk/juice → deficiencies in Vit C, riboflavin, phosphorous, calcium
Males: ↑ risk of supplement/protein drink use; may restrict calories for sports weight
🍽️ Eating Disorders
Anorexia nervosa, bulimia nervosa, binge eating disorder commonly begin in adolescence
Social pressure + obesity stigma → poor body image especially in females
Crash diets can lead to eating disorders
🤰 Adolescent Pregnancy
⚠️Fetal demands compete with teen's own growth. Risks: anemia, pregnancy-induced hypertension, gestational diabetes, premature labor, miscarriage, low birth weight.
📋Refer pregnant adolescents to WIC (Women, Infant, and Children nutrition subsidy program)
Refer to: food programs, food banks, Meals on Wheels (housebound)
Medications can cause electrolyte losses
💧 Fluid Intake (Adults)
Classic "8×8" (64 oz/day) is a guideline — solid foods also provide water
For healthy adults: normal eating/drinking habits generally provide sufficient fluids
Encourage water and natural juices
Discourage soda pop and other caffeinated drinks as primary fluids
📝 NCLEX Practice
A nurse providing nutrition counseling for older adults should include which information? (Select all that apply)
A Increase protein to 50% of daily calories ✗
B The need for vitamins and minerals can increase ✓
C Up to 35% of daily calories should come from fat ✓
D At least 45% of daily calories should come from carbohydrates ✓
E Fruits and vegetables should make up one-third of each meal ✗ (should be HALF)
🍽️
Therapeutic Nutrition & Modified Diets
Therapeutic nutrition = the role of food and nutrition in the treatment of diseases and disorders. The basic diet becomes therapeutic when modifications are made to meet client needs.
Modifications include
↑ or ↓ caloric intake, fiber, or specific nutrients
Also includes
Omitting specific foods or modifying food consistency
Key reminder
Food meets physiological AND psychological needs — should be a pleasant experience
Collaboration
Nurses collaborate with the dietitian for nutritional/dietary concerns
🥗
Regular Diet (Normal / House Diet)
✅ Indicated for
Clients who do not need dietary restrictions
Adjusted to meet age-specific needs throughout the life cycle
Many facilities offer self-select menus
🔧 Modifications
Accommodate individual preferences
Respect food habits and ethnic values
💧
Clear Liquid Diet
⚠️ Nutritionally inadequate — should NOT be used long-term
What it is
Foods/fluids that are liquid at room temp with no residue
A nurse is caring for a client following an appendectomy with a prescription to "advance diet to clear liquids as tolerated." Which should the nurse offer? (Select all that apply)
A Applesauce ✗ (not clear liquid)
B Chicken broth ✓
C Sherbet ✗ (full liquid)
D Wheat toast ✗ (solid)
E Cranberry juice ✓
🥤
Full Liquid Diet
What it includes
Foods liquid at room temp
Plain ice cream, strained cereals
Some facilities include pureed vegetables
📋 Indications
Transition from liquid → soft diet
Postoperative recovery
Acute gastritis, febrile conditions
Intolerance of solid foods
⚠️ If used more than 3 days → may need protein & calorie supplementation
⚠️ Use cautiously with dysphagia unless liquids are thickened appropriately
ℹ️ Many dietary manuals have removed the full liquid diet — may be used infrequently
🫙
Blenderized Liquid (Pureed) Diet
What it is
Liquids and foods pureed to liquid form; each food pureed separately to preserve flavor
Boost calories
Add broth, milk, gravy, cream, soup, tomato sauce, or fruit juice instead of water
Customize
Modify calories, protein, fat based on client's needs
Indications: Chewing or swallowing difficulties · Oral or facial surgery · Wired jaws
📝 NCLEX Practice
A nurse is assessing dietary needs. For which clients should the nurse plan a blenderized liquid diet? (Select all that apply)
A Client with a wired jaw from MVA ✓
B Client 24 hr post-op temporomandibular joint repair ✓
C Client with difficulty chewing due to oral surgery ✓
D Client with hypercholesterolemia / CAD ✗ (needs cardiac diet)
E Client scheduled for colonoscopy ✗ (needs clear liquid)
Indications: Limited chewing ability · Dysphagia · Poorly fitting dentures · Edentulous (no teeth) · Head/neck/mouth surgery · Intestinal strictures
📝 NCLEX Practice
A nurse is assisting a client on a mechanical soft diet with food selections. Which are correct? (Select all that apply)
A Dried prunes ✗ (hard/chewy)
B Ground turkey ✓
C Mashed carrots ✓
D Fresh strawberries ✗ (seeds)
E Cottage cheese ✓
🫁
Dysphagia Diet (IDDSI Framework)
Prescribed when swallowing is impaired (e.g., post-stroke). Signs: drooling, pocketing food, choking, gagging.
Reference: www.iddsi.org
💧 Liquid Consistencies
Level 0 — Thin
Flows like water; consumed by cup or straw (age appropriate)
Level 1 — Slightly Thick
Thin enough to sip through straw, thicker than water
Level 2 — Mildly Thick
Does not hold shape when poured; spoon ok, straw requires effort
Level 3 — Moderately Thick
Smooth, no lumps; cup or spoon ok, not a fork
Level 4 — Extremely Thick
Holds shape; spoon only, not sticky, no chewing needed
🍴 Solid Textures
Level 3 — Liquidized
Same as Level 3 moderately thick liquid
Level 4 — Pureed
Same as Level 4 extremely thick; smooth, no lumps
Level 5 — Minced & Moist
Soft, visible lumps; fork or spoon ok; lumps easy to mash with tongue
Level 6 — Soft & Bite-Sized
Soft, moist, semi-solid; easily chewed and swallowed
Level 7 — Easy to Chew
Near-normal texture, moist, may have mixed consistency; hard/sticky foods eliminated
Level 7 — Regular
Normal everyday foods; vary in texture; developmentally age appropriate
📝 NCLEX Practice
A nurse is caring for a client on a Level 5 dysphagia diet following a stroke. Which dietary selection should the nurse offer?
A Turkey sandwich ✗ (bread too firm/mixed texture)
B Scrambled eggs ✓ (soft, moist, easy to mash)
C Peanut butter crackers ✗ (sticky, hard)
D Granola ✗ (hard, crunchy)
🩺
Nursing Assessment & Interventions
📊 Ongoing Assessment
Daily weights
Prescribed laboratory tests
Evaluate nutritional & energy needs
Evaluate response to diet therapy
Observe & document nutritional intake
Perform calorie count if needed
🔧 Nursing Actions
Provide education & support for diet therapy
Consult with dietitian
For "diet as tolerated" Rx: assess for hunger, appetite, and nausea
Post-major surgery diet progression: NPO → Clear Liquids → Full Liquids → Soft → Regular
⚠️ Assess for return of bowel function (bowel sounds + passage of flatus) before advancing diet
⚡
Quick Reference — Diet Comparison
Diet
Key Feature
Main Indication
Watch out
Regular
No restrictions
No dietary needs
Adapt for culture/preference
Clear Liquid
Liquid, no residue
Pre-procedure, acute illness
⚠️ Nutritionally inadequate
Full Liquid
Liquid at room temp
Transition liquid → soft
Supplement if >3 days
Pureed
Blended to liquid
Chewing/swallowing difficulty
Each food pureed separately
Soft/Bland
Low fiber, easy to digest
GI disorders, acute infection
⚠️ Causes constipation
Mechanical Soft
Minimal chewing
Dysphagia, dentures, edentulous
No seeds, nuts, dried fruit
Dysphagia (IDDSI)
Levels 0–7
Post-stroke, impaired swallowing
Match level to assessment
🔬
Enteral Nutrition (EN) — Overview
Enteral nutrition (EN) = used when a client cannot consume adequate nutrients orally but has a GI system that functions at least partially.
✅ Indications
Burns, trauma, prolonged intubation
Eating disorders, radiation/chemo therapy
Liver or renal dysfunction, infection
Inflammatory bowel disease
Neuromuscular impairment (cannot chew/swallow)
Infants: too weak to suck, unable to coordinate swallowing, lacks gag reflex, becomes fatigued/weak/cyanotic during feeding
🚫 Contraindicated when
GI tract is nonfunctional
Paralytic ileus
Intestinal obstruction
ℹ️ Key facts
Most closely utilizes body's own digestive/metabolic routes
Can augment oral diet OR be sole nutrition source
Commercial formulas preferred over home-blended
🧪
Enteral Feeding Routes
Short-Term: Nasoenteric Tubes (< 3–4 weeks)
Nasogastric (NG)
Nose → stomach
Nasoduodenal
Nose → stomach → duodenum; used for aspiration risk or gastroparesis
Nasojejunal
Nose → stomach → jejunum; used for aspiration risk or gastroparesis
Infant tube
Nares or mouth → stomach; flexible, can stay taped up to 30 days
Long-Term: Ostomies (surgically created stoma)
Used when long-term feeding needed, high aspiration risk, or nasal obstruction prevents nasal tube insertion.
Gastrostomy (PEG)
Placed into stomach via endoscope. Well-tolerated; avoids dumping syndrome. Physiologic release promotes effective digestion.
Low-profile gastrostomy (skin-level device)
More comfortable, longer lasting, fully immersible in water. Checking residual is harder due to button close to skin.
Jejunostomy
Surgically inserted into the jejunum (small intestine)
📝 NCLEX Practice
A nurse is discussing a low-profile gastrostomy device with the guardian of a child receiving EN. Which statement should the nurse make?
A "The device is usually comfortable for children." ✓
B "Checking residual is much easier with this device." ✗ (it is harder)
C "This access requires less maintenance than a nasal tube." ✗
D "Mobility of the child is limited with this device." ✗
Standard formulas = low residue → good post-bowel surgery or bowel rest
Fiber-enriched = for constipation or diarrhea (normalizes BMs)
Fats/carbs modified for respiratory disease, malabsorption, DM, kidney disease
Packaging: Cans or prefilled bags · Prefilled bags + tubing discarded every 24 hr · Generic bags filled with only 4 hr worth of formula
📝 NCLEX Practice
A nurse is teaching a client starting continuous EN feedings about formula types. Which should the nurse include?
A Formula rich in fiber is recommended when starting EN ✗
B Standard formula contains whole protein ✓
C (not listed in source)
D High-calorie formula has increased water content ✗ (it has decreased water)
⏱️
Enteral Feeding Delivery Methods
Continuous Infusion
Constant rate over 24 hr via infusion pump · Best for critically ill (↓ residuals, ↓ aspiration/diarrhea risk) · Flush with ≥30 mL water every 4 hr · GRV check every 4–6 hr
Cyclic Feeding
Continuous rate for 8–20 hr, often overnight · Used to transition from EN → oral intake
Intermittent
Every 4–6 hr in equal portions over 30–60 min (range 20–90 min) · For noncritical clients, home feedings, rehab · Resembles normal eating pattern
Bolus
250–400 mL via large syringe over ≥15 min, 4–6×/day · Stomach only (contraindicated for jejunum/duodenum) · Can cause dumping syndrome · Infants: ≤5 mL/10 min (premature); 10 mL/min (older)
⚠️ GRV thresholds: Adults → >250 mL on two consecutive checks · Children → >¼ of prescribed volume
📝 NCLEX Practice
A nurse is instructing a client about cyclic EN feedings at home. Which should the nurse include? (Select all that apply)
A "Give a feeding every 6 hours." ✗ (cyclic = continuous overnight, not every 6 hr)
B "Set the feeding up before you go to bed." ✓
C "Weigh yourself daily." ✓
D "Flush the tube with a carbonated beverage to dislodge clogs." ✗ (not approved)
E "Ensure your head is elevated to 15 degrees during administration." ✗ (must be ≥30°)
📝 NCLEX Practice
A nurse is preparing to administer intermittent EN feedings. Which actions should the nurse take? (Select all that apply)
A Fill the feeding bag with 24 hr worth of formula ✗ (only 4 hr worth for generic bags)
B Discard feeding equipment after 24 hr ✓
C Ensure the formula is at room temperature ✓
D Flush the feeding tube immediately following the feeding ✓
E Elevate head of bed for 15 min after ✗ (must be 30–60 min)
📝 NCLEX Practice
A nurse is administering bolus EN feedings to a client with malnutrition. Which are appropriate? (Select all that apply)
A Verify the presence of bowel sounds ✓
B Flush the feeding tube with warm water ✓
C Elevate the head of the bed 20° ✗ (must be ≥30°)
D Administer the feeding at room temperature ✓
E Instill the formula over 60 min ✗ (bolus = ≥15 min, not 60 min)
🩺
Nursing Actions
🔧 Preparation
Verify tube placement by radiography before first use
Mark tube with indelible ink/tape at nose exit; document
Measure tube each shift and before each feeding to check for migration
Aspirating contents + pH NOT reliable for initial placement verification
Verify bowel sounds present
Flush with warm water to maintain patency
HOB elevated ≥30° during feedings and 30–60 min after
Start with small volume of full-strength formula; increase as tolerated
Administer at room temperature
⚠️ Do NOT heat in microwave (uneven temperatures)
Burp infant after feeding if condition allows
📊 Baseline Parameters
Height, weight, BMI · BUN, albumin, hemoglobin, hematocrit, glucose, electrolytes · Registered dietitian evaluates nutritional/energy needs · Verify GI function
Infants/children: flush = 1.5× the tube prime volume
🔄 Weaning & Transitioning
Discontinue EN when client consumes ⅔ of protein & calorie needs orally for 3–5 days Transition to oral: Stop EN 1 hr before meals → increase meal frequency → up to 6 small meals/day → when oral intake = 500–750 cal/day, give tube feeding only at night
NPO clients need meticulous oral care · Long-term EN may need home nutritional support (interprofessional team: nurse, dietitian, pharmacist, provider)
⚠️
Complications & Nursing Actions
🫀 GI Complications
Constipation, diarrhea, cramping, pain
Abdominal distention, N&V
Dumping syndrome — rapid emptying into small intestine → fluid shift → dizziness, rapid pulse, diaphoresis, pallor, lightheadedness
Nursing Actions
Consider formula change
↓ Flow rate or total volume
↑ Free water if constipated
Administer at room temperature
Prevent bacterial contamination
🔧 Mechanical Complications
Tube misplacement/dislodgement
Aspiration
Irritation/leakage at insertion site
Nose, esophagus, mucosa irritation
Tube clogging
Nursing Actions
Confirm placement before feedings
HOB ≥30° during + 60 min after
Bolus feedings over ≥15 min
Flush with ≥30 mL water every 4 hr (continuous), before/after bolus, before/after each med
Unclog: gentle pressure with 30–50 mL warm water in 60 mL piston syringe
⚠️ Carbonated beverages NOT approved for unclogging
Do NOT mix meds with formula
🧪 Metabolic Complications
Dehydration, hyperglycemia
Electrolyte imbalances, fluid overload
Rapid weight gain
Refeeding syndrome — potentially fatal; occurs when starved client is restarted on EN (greater risk with parenteral nutrition)
Nursing Actions
Provide adequate free water
Consider isotonic formula
Restrict fluids if fluid overloaded
Monitor electrolytes, blood glucose, weights
Monitor respiratory, cardiovascular, neurologic status
Administer insulin per protocol for hyperglycemia
🦠 Foodborne Illness (Bacterial Contamination)
Wash hands before handling formula
Clean equipment and tops of formula cans
Use closed feeding systems
Label open cans with client name, room, date & time
Replace bag, tubing, and equipment every 24 hr
Fill generic bags with only 4 hr worth of formula
⚡
Quick Reference — Key Numbers to Know
HOB elevation
≥ 30°
During feedings AND 30–60 min after
Flush (continuous)
≥ 30 mL / 4 hr
Warm water to maintain patency
GRV adult threshold
> 250 mL × 2
Two consecutive checks (100–500 mL single measurement range)
Bolus volume
250–400 mL
Over ≥ 15 min, 4–6×/day
Wean EN when
⅔ oral intake
For 3–5 consecutive days
Generic bag max fill
4 hr only
Discard all equipment every 24 hr
Nasoenteric tubes
< 3–4 weeks
Short-term use only
Unclog tube with
30–50 mL warm water
60 mL piston syringe — NOT carbonated beverages
🌱
Sources of Nutrition — Overview
Nutrients absorbed in the diet determine, to a large degree, the health of the body. Deficiencies or excesses contribute to poor health. Essential nutrients = those the body cannot manufacture; their absence causes deficiency diseases.
Energy-yielding nutrients
Carbohydrates, fats, and proteins
Other components
Vitamins, minerals, electrolytes, water, fiber
Healthy eating pattern
Provides ALL essential nutrients from a broad assortment of food sources
📐
Dietary Reference Intakes (DRIs)
Developed by the Institute of Medicine. Used to understand food intake patterns, plan nutrition programs (e.g., SNAP), and help individuals.
RDA — Recommended Dietary Allowance
Amount most healthy people of similar life-stage and sex need to decrease risk of chronic disease
EAR — Estimated Average Requirement
Meets basic requirements for half the population; used by researchers/policy makers to determine RDAs
AI — Adequate Intake
Amount most people in a group consume; used when insufficient data exists to establish an RDA
UL — Tolerable Upper Intake Level
Maximum an individual should consume; used when a nutrient has known adverse effects
AMDR — Acceptable Macronutrient Distribution Ranges
Recommended percentages of intake for energy-yielding nutrients (carbs, fat, protein)
⚠️ Clients can use DRIs as a guide but should also consider individual factors that increase needs (disease, injury).
🌾
Carbohydrates & Fiber
Composition
Organic compounds of carbon, hydrogen, oxygen (CHO)
Key facts: Liver converts fructose & galactose → glucose → triggers insulin release → moves glucose into cells · Body digests 95% of starch in 1–4 hr (pancreatic amylase in small intestine) · Glycogen = stored energy in liver & muscles (limited supply) · Protein-sparing effect = adequate carbs spare protein for its own functions
Fiber
Indigestible substance in plant foods
Types: pectin, gum, cellulose, oligosaccharides
Adds bulk, stimulates peristalsis → aids elimination
Lowers cholesterol, reduces intestinal cancer risk
Polyunsaturated — corn, wheat germ, soybean, safflower, sunflower, fish
Essential fatty acids (omega-3 & omega-6) — blood clotting, BP, inflammation, metabolic processes; must come from diet
Phospholipids & Sterols
Phospholipids (e.g., lecithin) — cell membrane structure; transport fat-soluble substances
Sterols (e.g., cholesterol) — found in animal tissue; liver produces enough; excess builds up → ↑ CVD risk
Lipoproteins
VLDL — carries triglycerides to cells
LDL — carries cholesterol to tissue ("bad")
HDL — removes excess cholesterol → liver ("good")
⚠️ High fat diet → CVD, hypertension, diabetes · Children under 2 need higher fat for brain development · Diet <10% fat → insufficient essential fatty acids → cachectic (wasting) state · Lipid metabolism occurs mainly in small intestine (bile from gallbladder + pancreatic lipase)
💊
Vitamins
13 essential vitamins · Catalyst for metabolic functions & chemical reactions · Yield no usable energy but needed for energy to be metabolized · Fat-soluble (A, D, E, K) can cause toxicity — stored long-term · Water-soluble (C, B-complex) generally not stored
💧 Water-Soluble Vitamins
Vitamin
Major Action
Major Sources
Deficiency
Vitamin C
Antioxidant, tissue building, iron absorption, immune function, collagen formation
Citrus fruits, tomatoes, peppers, green leafy veggies, strawberries
Scurvy — bleeding, painful joints, swollen gums, loose teeth; ↑ need with smoking (+35 mg/day)
Thiamin (B1)
Coenzyme in energy metabolism, appetite, nerve/muscle function
Bone demineralization, rickets, osteomalacia · Excess → hypercalcemia
Vitamin E
Antioxidant; preserves lung & RBC membranes; protects Vitamin A from oxidation
Vegetable oils, grains, nuts, dark green veggies
Rare — anemia; edema & skin lesions in infants
Vitamin K
Blood clotting (prothrombin synthesis), bone maintenance
Carrots, eggs, dark green veggies (spinach, broccoli, asparagus)
Increased bleeding time · Antidote for excess anticoagulants (warfarin)
📝 NCLEX Practice
A nurse is discussing nutrient deficiencies. Which conditions are associated with a deficiency of Vitamin C? (Select all that apply)
A Dysrhythmias ✗
B Scurvy ✓
C Pernicious anemia ✗ (B12 deficiency)
D Megaloblastic anemia ✗ (folate/B12 deficiency)
E Bleeding gums ✓
⚗️
Minerals & Electrolytes
Minerals = inorganic elements used at every cellular level · Major minerals (>5 g in body; need ≥100 mg/day): Ca, P, Na, K, Mg, Cl, S · Trace minerals (<5 g; need ≤20 mg/day): Fe, I, Zn, Cu, Mn, Cr, Se, Mo, F · Electrolytes = electrically charged minerals that maintain homeostasis (Na, K, Cl)
Major Minerals
Mineral
Major Actions
Sources
Deficiency
Excess / Nursing
Sodium (Na)
Fluid volume, muscle contractions, nerve impulses
Table salt, processed foods
Muscle cramping, memory loss, anorexia
Fluid retention, hypertension, disorientation · Monitor LOC, edema, BP
Sources: fruits, vegetables, green tea, legumes, whole grains, broccoli
⚠️ No recommendations for intake exist at this time
Nutrients of Public Health Concern
Vitamin D · Calcium · Sodium · Potassium · Vitamin A · Vitamin E
📝 NCLEX Practice
A nurse is reviewing dietary recommendations at a health fair. Which information should the nurse include?
A "Fats should be 5%–15% of daily calorie intake." ✗ (AMDR is 20–35%)
B "Make protein 10%–35% of total calories each day." ✓
C "Consume 1,500 mL of water from liquids and solids daily." ✗ (1,500 mL is the minimum total intake; females need 2.7 L, males 3.7 L)
D "The body needs 40 mg of iron each day." ✗
🔄
Ingestion, Digestion, Absorption & Metabolism
Ingestion
Consuming food by mouth and moving it through the digestive system
Digestion
Systemic process of breakdown and absorption of nutrients
Absorption
Nutrients pass through the digestive system into the bloodstream and lymphatic system
Metabolism
All chemical processes at cellular level to maintain homeostasis; comprised of catabolism + anabolism
Catabolism
Breaking down substances with resultant release of energy
Anabolism
Using energy to build or repair substances
Energy nutrient storage & processing:
Glucose → glycogen → stored in liver & muscle · Surplus glucose → fat · Glycerol + fatty acids → triglycerides → stored in adipose tissue · Amino acids → body proteins · Liver removes nitrogen from amino acids → remainder converted to glucose or fat · Body cells use ATP first, then glycogen, then stored fat
⚡
Metabolic Rate
BMR / BEE
Basal Metabolic Rate — energy for involuntary activities over 24 hr, measured at rest after a 12-hr fast; affected by lean body mass, hormones, body surface area, age, sex
RMR / REE
Resting Metabolic Rate — same as BMR but does not require 12-hr fast
Sex differences
Males assigned at birth generally have higher metabolic rate due to more muscle mass and less fat
Measure BMR indirectly
Thyroid function tests can be used as an indirect measure of BMR
⬆️ Increase BMR
Lean, muscular body build
Exposure to extreme temperatures
Prolonged stress
Rapid growth (infancy, puberty)
Pregnancy and lactation
Physical conditioning
⬆️ Conditions that Increase Metabolism
Fever, shivering (involuntary muscle tremors)
Hyperthyroidism, Parkinson's disease
Cancer, cardiac failure, burns
Surgery/wound healing, HIV/AIDS
💊 Meds that Increase BMR
Epinephrine · Levothyroxine · Ephedrine sulfate
⬇️ Decrease BMR
Short, overweight body build
Starvation/malnutrition
Age-related loss of lean body mass
⬇️ Conditions that Decrease Metabolism
Hypothyroidism
💊 Meds that Decrease BMR
Opioids · Muscle relaxants · Barbiturates
⚠️ Acute stress → ↑ metabolism, ↑ blood glucose, ↑ protein catabolism · Protein deficiency from stress → skin breakdown, delayed wound healing, infections, organ failure, ulcers, impaired medication tolerance · Protein requirements may increase to >2 g/kg or up to 25% of total calories during acute stress · Any catabolic illness (surgery, burns) ↑ caloric requirements · Disease + sepsis → can lead to starvation/death
📝 NCLEX Practice
A nurse is reviewing prescribed medications for newly admitted clients. Which medications decrease the BMR? (Select all that apply)
A Epinephrine ✗ (increases BMR)
B Levothyroxine ✗ (increases BMR)
C Opioid ✓
D Barbiturate ✓
E Ephedrine sulfate ✗ (increases BMR)
⚖️
Nitrogen Balance
Nitrogen balance = difference between daily intake vs. excretion of nitrogen. Also an indicator of tissue integrity.
Neutral (Equilibrium)
Intake = excretion · Healthy stable adult
Positive Balance ⬆️
Intake > excretion → body builds more tissue than it breaks down · Normal in: infancy, childhood, adolescence, pregnancy, lactation
Negative Balance ⬇️
Excretion > intake → insufficient protein; body breaking down more than building · Seen in: illness, trauma, aging, malnutrition, critical illness, starvation
📝 NCLEX Practice
A nurse is caring for a client with negative nitrogen balance. Which are possible causes? (Select all that apply)
A Critical illness ✓
B Starvation ✓
C Adolescence ✗ (positive nitrogen balance)
D Trauma ✓
E Pregnancy ✗ (positive nitrogen balance)
🩺
Assessment, Data Collection & Nursing Interventions
📊 Assessment / Data Collection
Weight and history of recent weight patterns
Medical history (diseases affecting metabolism/nitrogen balance)
Clinical findings of malnutrition: pitting edema, hair loss, wasted appearance
Medication adverse effects that affect nutrition
Usual 24-hr dietary intake
Use of nutritional, herbal supplements, vitamins, minerals
Use of alcohol, caffeine, nicotine
🔧 Nursing Interventions
Monitor food intake
Monitor fluid intake and output
Use client-centered approach for disease-specific ingestion/digestion/medication problems
Collaborate with dietitian
Provide adequate calories and high-quality protein
🍽️ Strategies to Increase Protein & Calories
Add skim milk powder to milk (double-strength milk)
Use whole milk instead of water in recipes
Add cheese, peanut butter, hard-boiled eggs, or yogurt to foods
Dip meats in eggs or milk; coat with breadcrumbs before cooking
Nuts and dried beans — great alternatives for dairy allergy/lactose intolerance
📋
Nutrition Assessment — Overview
Nurses play a key role in assessing nutritional needs — monitoring, intervening, and teaching. A collaborative, interprofessional approach provides the best outcomes. TJC requires nutrition screening within 24 hours of inpatient admission, with dietitian referral for clients at risk for malnutrition.
Provider/Nurse role
Collect physical assessment data; serve as liaison between health care team and dietitian
Registered Dietitian role
Complete comprehensive nutritional assessments
Nurse ongoing role
Monitor and evaluate interventions; incorporate family nutritional habits into plan of care
Important reminder
A healthy-appearing client can still be malnourished — consider cultural, social, and physical norms
📝
Diet History
Assessment of usual foods, fluids, and supplements. Part of the nutrition screening to determine malnutrition issues.
Components of Diet History
Time, type, and amount of food for each meal and snacks
Time, type, and amount of all fluids (water, coffee/tea, carbonated, caffeinated)
Type, amount, and frequency of "special foods" (celebration foods, movie foods)
Typical food/fluid preparation (e.g., coffee with sugar, fried foods)
Number of meals eaten away from home
Type of preferred or prescribed diet (vegetarian, 2 g sodium/low-fat)
Foods avoided due to allergy or preference
Frequency and dose of medications or nutritional supplements
Satisfaction with diet over a specified time frame (last 3 months, 1 year)
🩺
Physical Assessment — Manifestations of Malnutrition
Hair that is dry or brittle
Skin with dry patches or poor wound healing / sores
Measures protein levels; affected by non-nutritional factors (injury, kidney disease)
Prealbumin (thyroxine-binding protein)
15–36 mg/dL
Sensitive; reflects acute changes; used for critically ill; <10.7 mg/dL = severe deficiency; monitors TPN effectiveness; more expensive, not routine; ↓ with inflammation
Assess factors that might alter nutrient intake beyond just food choices
Consult provider about altering treatment plan (e.g., different med to prevent anorexia; add antiemetic)
Schedule activities to prevent interruptions at mealtime; avoid fatigue, nausea, or pain before meals
📝 NCLEX Practice
A nurse is teaching about osteoporosis risk factors. Which should the nurse include? (Select all that apply)
A Inactivity ✓
B Family history ✓
C BMI 30 or greater ✗ (obesity may actually increase bone density)
D Hyperlipidemia ✗
E Cigarette smoking ✓
🥦
Dietary Guidelines for Americans (2020–2025)
Published jointly by USDA and HHS every 5 years. The 2020–2025 edition is the first to provide recommendations by life stage (birth through older adulthood). Evidence-based advice on food intake and physical activity.
4 Overarching Guidelines
Guideline 1 — Healthy Pattern
Follow a healthy dietary pattern at every stage of life · First ~6 months: human milk or iron-fortified formula + supplemental Vitamin D soon after birth · ~6 months: introduce nutrient-dense complementary foods from all food groups · 12 months → older adulthood: healthy pattern that meets needs, achieves healthy weight, reduces chronic disease risk
Guideline 2 — Customize
Enjoy nutrient-dense food and beverage choices reflecting personal preferences, cultural traditions, and budget
Guideline 3 — Nutrient-Dense
Meet food group needs with nutrient-dense foods and stay within calorie limits · Core elements: all vegetable types, whole fruits, grains (≥½ whole grain), dairy (fat-free/low-fat), protein foods, oils
⚠️ Food safety: Avoid raw eggs and unpasteurized milk/juices · When cooking at home: add frozen veggies/legumes to convenience foods; reduce salt; buy nutrient-adding sides (salad kits, pre-cut fruit, whole-grain bread) · When eating out: eat high-fiber snack 1 hr before; eat lighter other meals that day; ask for high-fat items on the side; choose restaurants with healthy options
📝 NCLEX Practice
A nurse is conducting a nutrition class at a community center. Which information should the nurse include?
A Limit saturated fat to less than 10% of total daily intake ✓
B Good bowel function requires 35 g/day of fiber for females ✗ (females need 25 g/day)
C Limit cholesterol to 400 mg/day ✗ (no specific mg limit in current guidelines)
D Normal cardiac function depends on B-complex vitamins ✗ (neurologic, not cardiac)
🍽️
MyPlate & Physical Activity
🏃 Physical Activity
One of the most important things to improve overall health
Vegetarian diets can meet all nutrient recommendations with variety and correct portions · Can reduce risk of ischemic heart disease, type 2 diabetes, certain cancers · Vegans especially at risk for deficits in: Vitamin D, Vitamin B12, Calcium, Omega-3 fatty acids
📝 NCLEX Practice
A nurse is teaching a client who follows vegan dietary practices. The nurse should instruct the client about risk of deficit in which nutrients? (Select all that apply)
A Vitamin D ✓
B Fiber ✗ (plant-based diets are typically high in fiber)
C Calcium ✓
D Vitamin B12 ✓
E Whole grains ✗ (not a nutrient; available in vegan diet)
🏷️
Understanding Food Labels
FDA requires food labels on packaged foods. Labels must include: product name/form, net amount, manufacturer/distributor name and address. % Daily Values based on 2,000 cal/day diet. Ingredients listed in descending order by weight.
Required Nutrients on Label
Calories (larger bold type)
Total fat · Saturated fat · Trans fat
Cholesterol · Sodium
Total carbohydrates · Dietary fiber
Sugars (grams + % DV)
Protein
Vitamin D · Potassium · Calcium · Iron
Additional Label Rules
Must clearly state if food contains any of the 8 major allergens (milk, eggs, fish, shellfish, tree nuts, peanuts, wheat, soybeans) — responsible for 90% of food allergies
Functional foods — whole or additive-enhanced foods marketed for health benefits; currently no regulations
Organic foods — regulated by USDA; no pesticides/synthetic fertilizers; livestock graze, fed 100% organic feed, no hormones/antibiotics
Organic foods: may reduce antibiotic resistance risk; no evidence of health superiority
Meet minimum MyPlate servings for fruit, vegetable, and whole grain groups
🎗️ Cancer Prevention
Well-balanced diet (MyPlate) + healthy weight
↑ High-fiber plant-based foods
Limit saturated and trans fat; emphasize omega-3 polyunsaturated fats
Limit sodium intake
Avoid excess alcohol
Regular physical activity
📝 NCLEX Practice
A nurse is discussing essential nutrients for normal neurologic functioning. Which should the nurse include? (Select all that apply)
A Calcium ✓
B Thiamin ✓
C Vitamin B6 ✓
D Sodium ✓
E Phosphorus ✗ (bone health, not neurologic)
🛡️
Food Safety — Overview
Nurses must educate clients on food safety and food-medication interactions. Key concerns: aspiration prevention, foodborne illness, food allergies, food-medication interactions.
Aspiration Risk
Food only for conscious clients with intact gag/swallow reflex · Monitor swallowing post-stroke or post-esophageal anesthesia · Young children at increased risk
⚠️ Canned goods: Check for rusting, crushing, denting, or stickiness (indicates leakage) — do NOT use damaged cans
🍳
Handling, Preparation & Packaging Labels
🤲 Handling Guidelines
Wash hands and food preparation surfaces frequently and before handling food
Separate foods to avoid cross-contamination
🌡️ Preparation — Cook to Proper Temperature + 3-min rest
Roasts & Steaks
145°F (63°C)
Chicken
165°F (74°C)
Ground Beef
160°F (71°C)
Egg-containing products
160°F (71°C)
🏷️ Packaging Labels
Sell-by date — final recommended day of sale
Use-by date — how long product maintains top quality
Expiration date — final day product should be used or consumed
🦠
Foodborne Illness
⚠️ Greatest risk to: children, older adults, immunocompromised clients, pregnant clients
🦠 Viruses cause most foodborne illnesses · Bacteria responsible for most deaths
High-Risk Foods
Raw or undercooked foods of animal origin
Raw fruits and vegetables contaminated with animal feces
Raw sprouts · Unpasteurized fruit juice and milk products
Headache, fever, abdominal cramping, diarrhea, N&V · Can be fatal
E. coli O157:H7
Bacterial
Raw/undercooked meat, especially ground beef
Severe abdominal pain, diarrhea · Can cause hemolytic uremic syndrome (severe anemia + kidney failure)
Listeria monocytogenes
Bacterial
Soft cheese, raw milk, undercooked poultry, processed meats, raw vegetables
Sudden fever, diarrhea, headache, back pain, abdominal discomfort · High risk for newborns, pregnant, immunocompromised · Can cause stillbirth or miscarriage
Norovirus
Viral
Contaminated fruits/vegetables, salads prepared by infected person, oysters, contaminated water
A nurse is teaching about norovirus at a community center. Which information should the nurse include?
A Hand sanitizer will protect against norovirus ✗ (handwashing with soap and water is required)
B Pregnant clients are more susceptible ✗ (Listeria is more dangerous in pregnancy)
C Norovirus usually lasts 4–5 days ✗
D Onset is 24–48 hours after exposure ✓
⚠️
Food Allergies vs. Food Intolerance
🚨 Food Allergy
Reaction occurs every time the client is exposed to the food
Initiates release of serotonin and histamine
Common manifestations: N&V, diarrhea, abdominal distention and pain; some reactions severe
⚡ Food Intolerance
Does not occur consistently
Dependent on the amount of food eaten
8 Most Reported Food Allergies: Milk · Peanuts · Fish · Eggs · Soy · Shellfish · Tree nuts · Wheat
⚠️ Some infants react to cow's milk and/or soy — typically outgrow by age 4
💊
Food-Medication Interactions
📈 Food Affects Drug Absorption
Increased absorption — improves peak effects of some drugs when taken with food
Decreased absorption — food can delay onset (rate ↓) or reduce intended effect (extent ↓)
Some meds must be taken with food to avoid gastric irritation: ibuprofen, amoxicillin, bupropion (some antidepressants)
⚗️ Foods That Alter Metabolism/Drug Action
Grapefruit juice — interferes with metabolism of many meds → ↑ blood levels of medication
Vitamin K foods (dark green veggies, eggs, carrots) — ↓ anticoagulant effects of warfarin
High-protein foods — ↑ metabolism of levodopa (anti-Parkinson's) → ↓ absorption and transport to brain
Tyramine (aged cheese, smoked meats, dried fish, overripe avocados) — metabolized by MAO; clients on MAOIs (phenelzine, selegiline) who eat tyramine-rich foods → hypertensive crisis
Herbal supplements — can interact with prescribed meds; must be discussed with provider
📝 NCLEX Practice
A nurse is teaching a client starting the MAOI selegiline. Which food could cause a hypertensive crisis?
A Grapefruit juice ✗ (affects drug levels, not MAOI/tyramine crisis)
B Dark green vegetables ✗ (affects warfarin)
C Greek yogurt ✗
D Smoked fish ✓ (high tyramine → hypertensive crisis with MAOIs)
Nursing Assessment & Interventions: Complete dietary profile including medications, herbal supplements, baseline food safety knowledge · Teach about food safety and food-medication interactions · Teach the difference between food intolerance vs. food allergy
🌍
Cultural, Ethnic & Religious Influences — Overview
Cultural, ethnic, and religious considerations greatly affect nutritional health. Identifying and incorporating individual preferences promotes client-centered care and helps prevent ethnocentrism.
Acculturation
Process of a cultural/ethnic/religious group adopting the dominant culture's behaviors, beliefs, and values
Foodway
Role of foods, food preparation, what is considered edible, timing of meals, use of food for health or other benefits
Food as symbol
Can represent: masculinity/femininity, love/punishment, connectedness, celebration/mourning, comfort
Food roles
Core = eaten most often · Secondary = eaten frequently but less than core · Peripheral = eaten occasionally (cost, availability, or special days)
Acculturation effects can be:
✅ Positive — if client includes more healthy foods
⚠️ Negative — if ↑ high-fat, high-calorie, or high-sodium foods · First-generation members more likely to follow traditional foodway; subsequent generations incorporate dominant culture's practices
👥
Selected Populations — Nutrition Profiles
Group
Key Facts
Nutrition-Related Concerns
Hispanic/Latinx
Largest minority group in U.S.; largest % Mexican heritage · Hot/cold balance beliefs; cinnamon, mint tea, chamomile tea for healing
↑ Fruit, dark green & orange veggies, legumes · ↑ Saturated fat & sodium · ↓ Whole grains & milk · High obesity prevalence · >2× risk of Type 2 DM
Black/African American
2nd largest minority group · Food habits tied more to personal factors (schedule, location, SES) than heritage · More likely to accept larger body size as normal
Just below national USDA healthy eating average · ↓ Whole grains, milk, vegetables · Highest obesity prevalence · ↑ DM with ↑ complications · ↑ Hypertension risk (often uncontrolled)
Asian American/Pacific Islander
3rd largest minority; 37 different ethnic groups; Chinese = largest subgroup · Considerable time/skill in food prep · Yin/yang balance beliefs · Yang foods: fried, coffee, spice, meat, broths · Yin foods: seaweed, fruits, veggies, cold beverages
Lowest obesity prevalence · Highest life expectancy (Asian American females) · ↑ Risk of Type 2 DM when body fat increases (vs. other groups)
🍜
Selected Cultural Diets
Diet
Traditional Foods
Acculturation Changes
Health Risks
American
Foods from many cultures; often prepared quickly; premade ingredients/kits
—
Convenience foods: high Na & cal, low fiber · Portion sizes on kits often small → overeating · Away-from-home meals: low in fruit, veggies, dairy, whole grains; high in fat, sugar, Na
↑ Wheat-based foods · ↑ Raw vegetables · ↑ Fruit · ↑ Dairy, meat, ethnic dishes, fast food
Most foods cooked · ↑ Sodium risk (salting/drying, salt-based condiments)
🥦 Vegetarian & Special Diets
Semi-vegetarian / Flexitarian
Mainly plant-based with occasional meat, poultry, dairy, or fish
Vegetarian
Typically omits meat, seafood, poultry; some include eggs, dairy, or occasional fish
Vegan (Pure)
No animal products of any type · Requires specific food combinations for all essential amino acids · Adequate protein with sufficient nuts & legumes · ⚠️ Risk: B12, Vitamin D, iron, calcium, zinc, omega-3
Raw Vegan
Uncooked plant-based foods only
Macrobiotic
Whole-foods diet based on locally grown plants; occasional fish or seafood
📝 NCLEX Practice
A nurse is caring for a client with hypertension. Which dietary pattern followed by Asian clients places them at risk for this condition?
A Incorporation of plant-based foods ✗ (protective)
B (not listed)
C Preparation of foods using sodium ✓ (salting/drying/condiments)
D Focus on shellfish ✗
✝️
Religion & Nutrition
Religion often has more influence on dietary practices than culture and crosses geographic boundaries. Always ask clients to describe their dietary preferences — individual variation within each religion is significant.
Practice
Orthodox Judaism
Islam
Hinduism/Buddhism
7th-Day Adventism
Mormon (LDS)
Roman Catholicism
Meat/dairy separate
✓ (pareve foods = neither)
—
—
—
—
—
No pork
✓
✓
✓
✓
—
—
No alcohol
—
✓
✓
✓
✓
—
No beef
—
—
✓ (Hinduism)
—
—
—
Ritual slaughter
✓ Kosher
✓ Halal
—
—
—
—
Vegetarian
—
—
✓ (ahimsa)
✓
—
—
No coffee/tea
—
—
—
✓
✓
—
Fasting
Yom Kippur (24 hr)
Ramadan (monthly)
✓ (partial/total)
5–6 hr between meals
—
No meat Ash Wed & Fridays in Lent; no food/drink 1 hr before communion
Fish rules
Fish must have scales & fins · Passover: unleavened bread only
Halal (permitted) vs. Haram (prohibited)
—
—
—
—
📝 NCLEX Practice
A nurse educator taught a class on culture and food. Which statement shows understanding?
A "Most Roman Catholics do not drink caffeinated beverages." ✗ (Mormons & Seventh-Day Adventists)
B "Most Orthodox Jews do not eat meat with dairy products." ✓
C "Most Mormons eat only animals slaughtered under strict guidelines." ✗ (that is Kosher/Halal — Judaism & Islam)
D "Most Hindus do not eat dairy products." ✗ (Hindus avoid beef, not dairy)
🩺
Nursing Interventions
❓ Questions to Ask Clients
What portions of diet are influenced by personal values?
What does the client consider healthy vs. unhealthy?
What does food and eating mean to the client?
When does the client eat, and is there a sequence to foods?
Who shops for and prepares the client's food?
Does the client abstain from any foods?
Are there restrictions related to food and preparation?
Are foods linked to religious or spiritual beliefs?
Do beliefs dictate fasting, feasting, or types of food on specific days?
🔧 Nursing Actions
Seek further information from reputable sources to guide nutritional counseling
If a cultural food is medically negative — ask client to reduce (not eliminate): smaller portions, less often
Suggest fruits and vegetables similar in taste/texture to preferred foods to increase adequate consumption
Consult dietitian to ensure essential nutrients are met while honoring cultural preferences
✏️ Quiz Yourself
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