HESI Nutrition Nursing Process I — Practice Test 2026/2027
HESI NUTRITION NURSING PROCESS I PRACTICE TEST
2026/2027 | 50 Questions | Exam Prep
Instructions: Select the best answer for each question. SATA items require selecting all correct responses.
Answers and rationales follow each question.
SECTION I: NUTRITIONAL ASSESSMENT & SCREENING
1. A nurse is conducting a nutritional assessment on a newly admitted patient. Which of the
following is the MOST reliable indicator of long-term protein status?
A. Serum albumin level
B. Prealbumin (transthyretin) level
C. Body mass index (BMI)
D. 24-hour dietary recall
Correct Answer: B. Prealbumin (transthyretin) level
Rationale: Prealbumin has a half-life of 2–3 days, making it a more sensitive and reliable indicator of
recent changes in protein-energy status than serum albumin, which has a half-life of approximately 20
days and is influenced by inflammation, hydration status, and liver disease. BMI reflects overall body
composition but does not specifically indicate protein status. A 24-hour dietary recall provides only a
snapshot of recent intake and is subject to recall bias. The Academy of Nutrition and Dietetics recommends
prealbumin as a preferred marker for monitoring response to nutrition support.
2. Select all that apply. A nurse is performing a Mini Nutritional Assessment (MNA) on an 82-
year-old resident in a long-term care facility. Which findings place this patient at increased
risk for malnutrition? [Select All That Apply]
A. Serum albumin of 2.8 g/dL
B. BMI of 27.5
C. Has lost 6 pounds in the last 3 months
D. Takes more than three prescription medications daily
E. Eats at least two full meals per day
Correct Answer: A. Serum albumin of 2.8 g/dL, C. Has lost 6 pounds in the last 3 months, D.
Takes more than three prescription medications daily
Rationale: Serum albumin below 3.5 g/dL (A) indicates hypoalbuminemia associated with malnutrition
and inflammation. Unintentional weight loss exceeding 5% in 1 month or 10% in 6 months (C) is a key
diagnostic criterion for malnutrition per AND/ASPEN criteria. Polypharmacy (D, defined as ≥3
medications) increases malnutrition risk due to drug-nutrient interactions, altered taste, dry mouth, and
GI side effects. A BMI of 27.5 (B) is classified as overweight and is not an independent risk factor for
malnutrition in this context. Eating at least two full meals daily (E) suggests adequate intake and does not
indicate risk.
3. A patient presents with a body mass index (BMI) of 17.2, poor wound healing, and
generalized muscle wasting. The nurse recognizes these findings are consistent with which
type of malnutrition?
A. Marasmus
B. Kwashiorkor
C. Mixed marasmic-kwashiorkor
D. Sarcopenic obesity
Correct Answer: A. Marasmus
Rationale: Marasmus is characterized by severe calorie deficiency resulting in significant fat and muscle
wasting, low BMI (<18.5), and weight loss. Unlike kwashiorkor, which presents with adequate caloric
intake but inadequate protein (causing edema, dermatitis, and sparse hair), marasmus involves overall
1
, HESI Nutrition Nursing Process I — Practice Test 2026/2027
energy depletion. Mixed marasmic-kwashiorkor features elements of both. Sarcopenic obesity involves
normal or elevated BMI with reduced muscle mass and increased fat mass, which does not match this
clinical picture. The patient's low BMI and muscle wasting are classic marasmus indicators.
4. When performing a physical examination for nutritional status, the nurse inspects the
patient's nails and finds spooning (koilonychia). The nurse should suspect a deficiency in
which nutrient?
A. Vitamin B12
B. Iron
C. Calcium
D. Zinc
Correct Answer: B. Iron
Rationale: Koilonychia (spoon-shaped nails) is a classic physical finding associated with iron deficiency
anemia. Iron is essential for hemoglobin synthesis and oxygen transport. Other physical findings of iron
deficiency include pallor, angular cheilitis, glossitis, and pagophagia (pica for ice). Vitamin B12 deficiency
typically presents with glossitis, peripheral neuropathy, and megaloblastic anemia. Calcium deficiency
presents with tetany, osteoporosis, and nail brittleness but not koilonychia. Zinc deficiency presents with
alopecia, impaired wound healing, and altered taste (dysgeusia).
5. A nurse in the emergency department is assessing a 65-year-old patient who reports
unintended weight loss of 15 pounds over the past 2 months, fatigue, and decreased appetite.
The patient lives alone and states, 'I just don't feel like cooking anymore.' Which action
should the nurse take FIRST?
A. Refer the patient to a registered dietitian immediately
B. Obtain a complete dietary history and assess for depression
C. Calculate the patient's BMI and compare it to admission weight
D. Initiate oral nutritional supplements and document intake
Correct Answer: B. Obtain a complete dietary history and assess for depression
Rationale: The nursing process prioritizes assessment first. This patient presents with multiple risk
factors for malnutrition: unintended weight loss exceeding 5% in 1 month (or >10% in 6 months), social
isolation, decreased appetite, and possible depression ('don't feel like cooking'). Before intervening, the
nurse must complete a thorough assessment including a dietary history and screening for depression using
a validated tool (e.g., Geriatric Depression Scale). While dietitian referral, BMI calculation, and nutritional
supplements are appropriate interventions, they should follow comprehensive assessment. Early
identification of depression as a contributing factor is critical, as untreated depression is a leading cause of
malnutrition in older adults.
6. The Malnutrition Screening Tool (MST) is validated for use in which patient population?
A. Pediatric patients aged 2–12 years
B. Hospitalized adult patients in acute care
C. Pregnant women in the third trimester
D. Athletes undergoing endurance training
Correct Answer: B. Hospitalized adult patients in acute care
Rationale: The Malnutrition Screening Tool (MST) is a validated, rapid screening tool specifically
designed for hospitalized adult patients in acute care settings. It consists of two questions: recent weight
loss and decreased appetite. A score of ≥2 indicates malnutrition risk and warrants further assessment.
Pediatric malnutrition screening uses tools such as the Pediatric Yorkhill Malnutrition Score (PYMS) or
STRONGkids. Pregnant women are assessed using tools that account for gestational weight gain. Athletes
are typically screened using sport-specific nutrition assessments.
2
, HESI Nutrition Nursing Process I — Practice Test 2026/2027
7. A nurse is implementing the nursing process for a patient identified as malnourished. Place
the following steps in the correct order (1 = first, 5 = last). [Ordered Response]
1. Assess the patient's current nutritional status using validated tools
2. Develop individualized nutrition care goals with the interdisciplinary team
3. Evaluate the patient's response and adjust the plan as needed
4. Implement the nutrition intervention, including diet modifications and supplements
5. Formulate a nursing diagnosis based on assessment findings
Correct Answer: 1 → 5 → 2 → 4 → 3
Rationale: The nursing process follows five sequential steps: Assessment (1) involves gathering data
about nutritional status using tools like the MNA or MST. Diagnosis (5) requires analyzing assessment
data to formulate a nursing diagnosis such as 'Imbalanced Nutrition: Less Than Body Requirements.'
Planning (2) involves setting measurable, individualized goals with the healthcare team. Implementation
(4) is the execution of the planned interventions including diet modifications, oral supplements, and
education. Evaluation (3) is the final step, where the nurse measures outcomes against goals and revises
the plan accordingly.
SECTION II: MACRONUTRIENTS & MICRONUTRIENTS
8. A patient with type 2 diabetes asks the nurse about carbohydrate counting. The nurse
explains that 15 grams of carbohydrate is approximately equivalent to which serving size?
A. One slice of whole-grain bread
B. One medium banana
C. One cup of cooked oatmeal
D. Two tablespoons of peanut butter
Correct Answer: A. One slice of whole-grain bread
Rationale: In the carbohydrate counting system, one carbohydrate exchange (or 'choice') equals
approximately 15 grams of carbohydrate. One slice of bread (A) contains roughly 15 g of carbohydrates
and serves as the standard reference. A medium banana (B) contains approximately 27 g of carbohydrates,
equivalent to about two choices. One cup of cooked oatmeal (C) provides approximately 27–30 g of
carbohydrates. Two tablespoons of peanut butter (D) contains only about 6 g of carbohydrates, primarily
as fiber. The American Diabetes Association recommends carbohydrate counting as a meal planning
approach for glycemic management.
9. A patient with end-stage renal disease on hemodialysis has elevated serum phosphorus
levels. The nurse should instruct the patient to limit which of the following foods?
A. Apples and pears
B. Chicken breast and rice
C. Dairy products and processed meats
D. Olive oil and avocados
Correct Answer: C. Dairy products and processed meats
Rationale: Dairy products (milk, cheese, yogurt) and processed meats are high in phosphorus, both
naturally occurring and as additives (phosphates used as preservatives). In ESRD, the kidneys cannot
excrete excess phosphorus, leading to hyperphosphatemia, which causes secondary hyperparathyroidism,
renal osteodystrophy, and cardiovascular calcification. Apples and pears (A) are low-phosphorus fruits.
Chicken breast and rice (B) contain moderate phosphorus but are not the highest sources. Olive oil and
avocados (D) are high in healthy fats but very low in phosphorus. Patients with hyperphosphatemia should
also be taught to take phosphate binders with meals.
10. A nurse is educating a patient about dietary sources of vitamin K. The nurse explains that
vitamin K is essential for which physiological process?
A. Calcium absorption and bone mineralization
3
HESI NUTRITION NURSING PROCESS I PRACTICE TEST
2026/2027 | 50 Questions | Exam Prep
Instructions: Select the best answer for each question. SATA items require selecting all correct responses.
Answers and rationales follow each question.
SECTION I: NUTRITIONAL ASSESSMENT & SCREENING
1. A nurse is conducting a nutritional assessment on a newly admitted patient. Which of the
following is the MOST reliable indicator of long-term protein status?
A. Serum albumin level
B. Prealbumin (transthyretin) level
C. Body mass index (BMI)
D. 24-hour dietary recall
Correct Answer: B. Prealbumin (transthyretin) level
Rationale: Prealbumin has a half-life of 2–3 days, making it a more sensitive and reliable indicator of
recent changes in protein-energy status than serum albumin, which has a half-life of approximately 20
days and is influenced by inflammation, hydration status, and liver disease. BMI reflects overall body
composition but does not specifically indicate protein status. A 24-hour dietary recall provides only a
snapshot of recent intake and is subject to recall bias. The Academy of Nutrition and Dietetics recommends
prealbumin as a preferred marker for monitoring response to nutrition support.
2. Select all that apply. A nurse is performing a Mini Nutritional Assessment (MNA) on an 82-
year-old resident in a long-term care facility. Which findings place this patient at increased
risk for malnutrition? [Select All That Apply]
A. Serum albumin of 2.8 g/dL
B. BMI of 27.5
C. Has lost 6 pounds in the last 3 months
D. Takes more than three prescription medications daily
E. Eats at least two full meals per day
Correct Answer: A. Serum albumin of 2.8 g/dL, C. Has lost 6 pounds in the last 3 months, D.
Takes more than three prescription medications daily
Rationale: Serum albumin below 3.5 g/dL (A) indicates hypoalbuminemia associated with malnutrition
and inflammation. Unintentional weight loss exceeding 5% in 1 month or 10% in 6 months (C) is a key
diagnostic criterion for malnutrition per AND/ASPEN criteria. Polypharmacy (D, defined as ≥3
medications) increases malnutrition risk due to drug-nutrient interactions, altered taste, dry mouth, and
GI side effects. A BMI of 27.5 (B) is classified as overweight and is not an independent risk factor for
malnutrition in this context. Eating at least two full meals daily (E) suggests adequate intake and does not
indicate risk.
3. A patient presents with a body mass index (BMI) of 17.2, poor wound healing, and
generalized muscle wasting. The nurse recognizes these findings are consistent with which
type of malnutrition?
A. Marasmus
B. Kwashiorkor
C. Mixed marasmic-kwashiorkor
D. Sarcopenic obesity
Correct Answer: A. Marasmus
Rationale: Marasmus is characterized by severe calorie deficiency resulting in significant fat and muscle
wasting, low BMI (<18.5), and weight loss. Unlike kwashiorkor, which presents with adequate caloric
intake but inadequate protein (causing edema, dermatitis, and sparse hair), marasmus involves overall
1
, HESI Nutrition Nursing Process I — Practice Test 2026/2027
energy depletion. Mixed marasmic-kwashiorkor features elements of both. Sarcopenic obesity involves
normal or elevated BMI with reduced muscle mass and increased fat mass, which does not match this
clinical picture. The patient's low BMI and muscle wasting are classic marasmus indicators.
4. When performing a physical examination for nutritional status, the nurse inspects the
patient's nails and finds spooning (koilonychia). The nurse should suspect a deficiency in
which nutrient?
A. Vitamin B12
B. Iron
C. Calcium
D. Zinc
Correct Answer: B. Iron
Rationale: Koilonychia (spoon-shaped nails) is a classic physical finding associated with iron deficiency
anemia. Iron is essential for hemoglobin synthesis and oxygen transport. Other physical findings of iron
deficiency include pallor, angular cheilitis, glossitis, and pagophagia (pica for ice). Vitamin B12 deficiency
typically presents with glossitis, peripheral neuropathy, and megaloblastic anemia. Calcium deficiency
presents with tetany, osteoporosis, and nail brittleness but not koilonychia. Zinc deficiency presents with
alopecia, impaired wound healing, and altered taste (dysgeusia).
5. A nurse in the emergency department is assessing a 65-year-old patient who reports
unintended weight loss of 15 pounds over the past 2 months, fatigue, and decreased appetite.
The patient lives alone and states, 'I just don't feel like cooking anymore.' Which action
should the nurse take FIRST?
A. Refer the patient to a registered dietitian immediately
B. Obtain a complete dietary history and assess for depression
C. Calculate the patient's BMI and compare it to admission weight
D. Initiate oral nutritional supplements and document intake
Correct Answer: B. Obtain a complete dietary history and assess for depression
Rationale: The nursing process prioritizes assessment first. This patient presents with multiple risk
factors for malnutrition: unintended weight loss exceeding 5% in 1 month (or >10% in 6 months), social
isolation, decreased appetite, and possible depression ('don't feel like cooking'). Before intervening, the
nurse must complete a thorough assessment including a dietary history and screening for depression using
a validated tool (e.g., Geriatric Depression Scale). While dietitian referral, BMI calculation, and nutritional
supplements are appropriate interventions, they should follow comprehensive assessment. Early
identification of depression as a contributing factor is critical, as untreated depression is a leading cause of
malnutrition in older adults.
6. The Malnutrition Screening Tool (MST) is validated for use in which patient population?
A. Pediatric patients aged 2–12 years
B. Hospitalized adult patients in acute care
C. Pregnant women in the third trimester
D. Athletes undergoing endurance training
Correct Answer: B. Hospitalized adult patients in acute care
Rationale: The Malnutrition Screening Tool (MST) is a validated, rapid screening tool specifically
designed for hospitalized adult patients in acute care settings. It consists of two questions: recent weight
loss and decreased appetite. A score of ≥2 indicates malnutrition risk and warrants further assessment.
Pediatric malnutrition screening uses tools such as the Pediatric Yorkhill Malnutrition Score (PYMS) or
STRONGkids. Pregnant women are assessed using tools that account for gestational weight gain. Athletes
are typically screened using sport-specific nutrition assessments.
2
, HESI Nutrition Nursing Process I — Practice Test 2026/2027
7. A nurse is implementing the nursing process for a patient identified as malnourished. Place
the following steps in the correct order (1 = first, 5 = last). [Ordered Response]
1. Assess the patient's current nutritional status using validated tools
2. Develop individualized nutrition care goals with the interdisciplinary team
3. Evaluate the patient's response and adjust the plan as needed
4. Implement the nutrition intervention, including diet modifications and supplements
5. Formulate a nursing diagnosis based on assessment findings
Correct Answer: 1 → 5 → 2 → 4 → 3
Rationale: The nursing process follows five sequential steps: Assessment (1) involves gathering data
about nutritional status using tools like the MNA or MST. Diagnosis (5) requires analyzing assessment
data to formulate a nursing diagnosis such as 'Imbalanced Nutrition: Less Than Body Requirements.'
Planning (2) involves setting measurable, individualized goals with the healthcare team. Implementation
(4) is the execution of the planned interventions including diet modifications, oral supplements, and
education. Evaluation (3) is the final step, where the nurse measures outcomes against goals and revises
the plan accordingly.
SECTION II: MACRONUTRIENTS & MICRONUTRIENTS
8. A patient with type 2 diabetes asks the nurse about carbohydrate counting. The nurse
explains that 15 grams of carbohydrate is approximately equivalent to which serving size?
A. One slice of whole-grain bread
B. One medium banana
C. One cup of cooked oatmeal
D. Two tablespoons of peanut butter
Correct Answer: A. One slice of whole-grain bread
Rationale: In the carbohydrate counting system, one carbohydrate exchange (or 'choice') equals
approximately 15 grams of carbohydrate. One slice of bread (A) contains roughly 15 g of carbohydrates
and serves as the standard reference. A medium banana (B) contains approximately 27 g of carbohydrates,
equivalent to about two choices. One cup of cooked oatmeal (C) provides approximately 27–30 g of
carbohydrates. Two tablespoons of peanut butter (D) contains only about 6 g of carbohydrates, primarily
as fiber. The American Diabetes Association recommends carbohydrate counting as a meal planning
approach for glycemic management.
9. A patient with end-stage renal disease on hemodialysis has elevated serum phosphorus
levels. The nurse should instruct the patient to limit which of the following foods?
A. Apples and pears
B. Chicken breast and rice
C. Dairy products and processed meats
D. Olive oil and avocados
Correct Answer: C. Dairy products and processed meats
Rationale: Dairy products (milk, cheese, yogurt) and processed meats are high in phosphorus, both
naturally occurring and as additives (phosphates used as preservatives). In ESRD, the kidneys cannot
excrete excess phosphorus, leading to hyperphosphatemia, which causes secondary hyperparathyroidism,
renal osteodystrophy, and cardiovascular calcification. Apples and pears (A) are low-phosphorus fruits.
Chicken breast and rice (B) contain moderate phosphorus but are not the highest sources. Olive oil and
avocados (D) are high in healthy fats but very low in phosphorus. Patients with hyperphosphatemia should
also be taught to take phosphate binders with meals.
10. A nurse is educating a patient about dietary sources of vitamin K. The nurse explains that
vitamin K is essential for which physiological process?
A. Calcium absorption and bone mineralization
3
