Med-Surg Week 8: Nutritional Support Exam
100 Practice Questions with Rationales for Nursing
Students
Section 1: Enteral Nutrition (Tube Feeding)
Questions 1–30
1. A client is prescribed enteral nutrition via a nasogastric (NG) tube. The nurse
understands that enteral nutrition is indicated for which client?
• A) A client with a functional GI tract who cannot swallow
• B) A client with complete bowel obstruction
• C) A client with severe pancreatitis requiring bowel rest
• D) A client with intractable vomiting
Answer: A) A client with a functional GI tract who cannot swallow
Rationale: Enteral nutrition is used when the GI tract is functional but oral intake is
inadequate or unsafe (e.g., dysphagia, neurological impairment). Complete bowel
obstruction, severe pancreatitis with bowel rest, and intractable vomiting are
indications for parenteral nutrition, not enteral.
2. A nurse is preparing to insert a nasogastric tube for enteral feeding. Which
position is most appropriate for the client?
• A) Supine with head flat
• B) High Fowler's position
• C) Left lateral position
• D) Trendelenburg position
, Answer: B) High Fowler's position
Rationale: High Fowler's position (sitting upright) facilitates passage of the tube
through the esophagus and reduces the risk of aspiration. The head should be tilted
forward slightly to close the trachea.
3. After inserting a nasogastric tube, which method is the most reliable for
confirming placement?
• A) Auscultation of air insufflation
• B) pH testing of aspirate
• C) X-ray confirmation
• D) Observing for bubbling when the tube is submerged in water
Answer: C) X-ray confirmation
Rationale: X-ray is the gold standard for confirming NG tube placement. While pH
testing (gastric pH ≤ 4) is a reliable bedside method, it does not definitively rule out
placement in the respiratory tract. Auscultation and bubbling are unreliable methods.
4. A nurse aspirates gastric contents from a client's NG tube and obtains a pH
of 7.5. What is the most appropriate action?
• A) Begin the tube feeding as ordered
• B) Flush with 30 mL of water
• C) Withhold feeding and notify the provider
• D) Advance the tube 5 cm
Answer: C) Withhold feeding and notify the provider
Rationale: Gastric aspirate pH should be ≤ 4. A pH of 7.5 may indicate placement in
the small intestine or, more concerning, the respiratory tract. Feeding should be
withheld until placement is confirmed by X-ray.
5. A nurse is initiating continuous tube feeding via a nasogastric tube. In which
position should the client be placed?
• A) Supine
,• B) Prone
• C) Head of bed elevated at least 30–45 degrees
• D) Trendelenburg
Answer: C) Head of bed elevated at least 30–45 degrees
Rationale: Elevating the head of bed (HOB) to 30–45 degrees reduces the risk of
aspiration during tube feeding. This position should be maintained continuously
during feeding and for at least 1 hour after.
6. A client receiving continuous tube feeding has a residual volume of 300 mL.
What should the nurse do?
• A) Discard the residual and continue the feeding
• B) Return the residual and continue the feeding
• C) Hold the feeding and notify the provider
• D) Increase the infusion rate
Answer: C) Hold the feeding and notify the provider
Rationale: Gastric residual volumes > 250–500 mL (varies by institution) may indicate
delayed gastric emptying and increase aspiration risk. The feeding should be held,
and the provider notified for further orders.
7. A nurse is administering an intermittent tube feeding via a gastrostomy tube.
After administering the feeding, the nurse should flush the tube with:
• A) 5 mL of water
• B) 30–60 mL of water
• C) 100 mL of juice
• D) 200 mL of normal saline
Answer: B) 30–60 mL of water
Rationale: Flushing with 30–60 mL of water before and after intermittent feedings
and medications maintains tube patency and prevents clogging. Larger volumes may
be used if specified.
, 8. Which complication is most common in clients receiving long-term enteral
nutrition via a nasogastric tube?
• A) Diarrhea
• B) Nasal mucosal erosion
• C) Constipation
• D) Hyperglycemia
Answer: B) Nasal mucosal erosion
Rationale: Long-term NG tube use can cause pressure-related complications
including nasal mucosal erosion, sinusitis, and esophageal strictures. For long-term
enteral nutrition (>4–6 weeks), a gastrostomy or jejunostomy tube is preferred.
9. A client with a percutaneous endoscopic gastrostomy (PEG) tube develops
redness, swelling, and purulent drainage at the insertion site. What is the
nurse's priority action?
• A) Clean the site with hydrogen peroxide
• B) Notify the provider of possible infection
• C) Apply a dry sterile dressing
• D) Rotate the tube 180 degrees
Answer: B) Notify the provider of possible infection
Rationale: Redness, swelling, and purulent drainage indicate infection at the PEG
site, which requires medical evaluation and possible antibiotic therapy. The site
should be cleaned with soap and water or normal saline (not hydrogen peroxide,
which can damage tissue).
10. A nurse is teaching a client's family about home enteral nutrition via a
gastrostomy tube. Which statement indicates correct understanding?
• A) "We will flush the tube with 100 mL of water after each feeding."
• B) "We should administer feedings with the client lying flat."
• C) "We will check the residual before each feeding."
• D) "We can crush all medications and mix them with the formula."
Answer: C) "We will check the residual before each feeding."
Rationale: Checking gastric residual before intermittent feedings helps assess gastric
emptying and reduce aspiration risk. Flushing typically uses 30–60 mL. The HOB
100 Practice Questions with Rationales for Nursing
Students
Section 1: Enteral Nutrition (Tube Feeding)
Questions 1–30
1. A client is prescribed enteral nutrition via a nasogastric (NG) tube. The nurse
understands that enteral nutrition is indicated for which client?
• A) A client with a functional GI tract who cannot swallow
• B) A client with complete bowel obstruction
• C) A client with severe pancreatitis requiring bowel rest
• D) A client with intractable vomiting
Answer: A) A client with a functional GI tract who cannot swallow
Rationale: Enteral nutrition is used when the GI tract is functional but oral intake is
inadequate or unsafe (e.g., dysphagia, neurological impairment). Complete bowel
obstruction, severe pancreatitis with bowel rest, and intractable vomiting are
indications for parenteral nutrition, not enteral.
2. A nurse is preparing to insert a nasogastric tube for enteral feeding. Which
position is most appropriate for the client?
• A) Supine with head flat
• B) High Fowler's position
• C) Left lateral position
• D) Trendelenburg position
, Answer: B) High Fowler's position
Rationale: High Fowler's position (sitting upright) facilitates passage of the tube
through the esophagus and reduces the risk of aspiration. The head should be tilted
forward slightly to close the trachea.
3. After inserting a nasogastric tube, which method is the most reliable for
confirming placement?
• A) Auscultation of air insufflation
• B) pH testing of aspirate
• C) X-ray confirmation
• D) Observing for bubbling when the tube is submerged in water
Answer: C) X-ray confirmation
Rationale: X-ray is the gold standard for confirming NG tube placement. While pH
testing (gastric pH ≤ 4) is a reliable bedside method, it does not definitively rule out
placement in the respiratory tract. Auscultation and bubbling are unreliable methods.
4. A nurse aspirates gastric contents from a client's NG tube and obtains a pH
of 7.5. What is the most appropriate action?
• A) Begin the tube feeding as ordered
• B) Flush with 30 mL of water
• C) Withhold feeding and notify the provider
• D) Advance the tube 5 cm
Answer: C) Withhold feeding and notify the provider
Rationale: Gastric aspirate pH should be ≤ 4. A pH of 7.5 may indicate placement in
the small intestine or, more concerning, the respiratory tract. Feeding should be
withheld until placement is confirmed by X-ray.
5. A nurse is initiating continuous tube feeding via a nasogastric tube. In which
position should the client be placed?
• A) Supine
,• B) Prone
• C) Head of bed elevated at least 30–45 degrees
• D) Trendelenburg
Answer: C) Head of bed elevated at least 30–45 degrees
Rationale: Elevating the head of bed (HOB) to 30–45 degrees reduces the risk of
aspiration during tube feeding. This position should be maintained continuously
during feeding and for at least 1 hour after.
6. A client receiving continuous tube feeding has a residual volume of 300 mL.
What should the nurse do?
• A) Discard the residual and continue the feeding
• B) Return the residual and continue the feeding
• C) Hold the feeding and notify the provider
• D) Increase the infusion rate
Answer: C) Hold the feeding and notify the provider
Rationale: Gastric residual volumes > 250–500 mL (varies by institution) may indicate
delayed gastric emptying and increase aspiration risk. The feeding should be held,
and the provider notified for further orders.
7. A nurse is administering an intermittent tube feeding via a gastrostomy tube.
After administering the feeding, the nurse should flush the tube with:
• A) 5 mL of water
• B) 30–60 mL of water
• C) 100 mL of juice
• D) 200 mL of normal saline
Answer: B) 30–60 mL of water
Rationale: Flushing with 30–60 mL of water before and after intermittent feedings
and medications maintains tube patency and prevents clogging. Larger volumes may
be used if specified.
, 8. Which complication is most common in clients receiving long-term enteral
nutrition via a nasogastric tube?
• A) Diarrhea
• B) Nasal mucosal erosion
• C) Constipation
• D) Hyperglycemia
Answer: B) Nasal mucosal erosion
Rationale: Long-term NG tube use can cause pressure-related complications
including nasal mucosal erosion, sinusitis, and esophageal strictures. For long-term
enteral nutrition (>4–6 weeks), a gastrostomy or jejunostomy tube is preferred.
9. A client with a percutaneous endoscopic gastrostomy (PEG) tube develops
redness, swelling, and purulent drainage at the insertion site. What is the
nurse's priority action?
• A) Clean the site with hydrogen peroxide
• B) Notify the provider of possible infection
• C) Apply a dry sterile dressing
• D) Rotate the tube 180 degrees
Answer: B) Notify the provider of possible infection
Rationale: Redness, swelling, and purulent drainage indicate infection at the PEG
site, which requires medical evaluation and possible antibiotic therapy. The site
should be cleaned with soap and water or normal saline (not hydrogen peroxide,
which can damage tissue).
10. A nurse is teaching a client's family about home enteral nutrition via a
gastrostomy tube. Which statement indicates correct understanding?
• A) "We will flush the tube with 100 mL of water after each feeding."
• B) "We should administer feedings with the client lying flat."
• C) "We will check the residual before each feeding."
• D) "We can crush all medications and mix them with the formula."
Answer: C) "We will check the residual before each feeding."
Rationale: Checking gastric residual before intermittent feedings helps assess gastric
emptying and reduce aspiration risk. Flushing typically uses 30–60 mL. The HOB
