HESI Nutrition Actual Exam / Nursing Nutrition Assessment Level 3
(2026/2027): 300 Practice Questions with Rationales —
Comprehensive Review for RN Success"
.
Section 1: Therapeutic Diets & Disease Management (Questions 1–40)
1. A client with type 2 diabetes asks the nurse about lifestyle changes. Which information is most
important to reinforce?
A) Avoid all carbohydrates.
B) Portion-controlled, heart-healthy diet selections.
C) Eliminate all fats from the diet.
D) Focus on high-protein, low-carb only.
Answer: B
Explanation: A portion-controlled, heart-healthy diet helps manage blood glucose, lipids, and weight.
Complete avoidance of carbs or fats is not recommended; a balanced approach is key.
2. A client taking antibiotics develops diarrhea and has several small bruises. Which dietary change
should the nurse offer?
A) Reduced cholesterol and fats.
B) Potassium-rich fruits.
C) Increased proteins rich in iron.
D) Foods rich in vitamin K.
Answer: D
Explanation: Antibiotics can disrupt gut flora and reduce vitamin K synthesis. Bruising suggests vitamin K
deficiency, which is essential for clotting. Yogurt can help restore gut bacteria, but vitamin K foods (e.g.,
green leafy vegetables) are needed.
3. A vegan patient is at greatest risk for deficiency of which nutrient?
A) Vitamin C.
B) Vitamin B12.
C) Vitamin E.
D) Iron.
,Answer: B
Explanation: Vitamin B12 is found almost exclusively in animal products. Vegans require fortified foods
or supplements to prevent deficiency.
4. A client with heart failure is prescribed a low-sodium diet. Which menu choice is appropriate?
A) Canned soup.
B) Baked chicken.
C) Processed deli meats.
D) Canned olives.
Answer: B
Explanation: Fresh, unprocessed foods like baked chicken are naturally low in sodium. Canned,
processed, and pickled items are typically high in sodium.
5. A client with celiac disease asks for safe food options. Which food should the nurse recommend?
A) Barley soup.
B) Rye bread.
C) Corn tortillas.
D) Wheat pasta.
Answer: C
Explanation: Corn is naturally gluten-free. Barley, rye, and wheat all contain gluten and must be
avoided.
6. A pregnant client in her first trimester reports nausea. Which intervention is best?
A) Drink fluids with meals.
B) Eat dry crackers before rising.
C) Eat large meals instead of small ones.
D) Avoid all carbohydrates.
Answer: B
Explanation: Dry crackers before getting out of bed help reduce morning sickness by stabilizing gastric
acids. Small, frequent meals are also recommended.
7. An older adult with poor dentition needs increased calorie intake. Which food is most appropriate?
A) Raw carrots.
B) Steak strips.
C) Yogurt with fruit.
D) Whole almonds.
,Answer: C
Explanation: Soft, high-calorie foods support intake when chewing is difficult. Yogurt with fruit is
nutrient-dense and easy to eat.
8. Which lab value indicates protein malnutrition?
A) Sodium 145 mEq/L.
B) Glucose 90 mg/dL.
C) Prealbumin 8 mg/dL.
D) Potassium 4.2 mEq/L.
Answer: C
Explanation: Prealbumin has a short half-life and reflects acute protein status. Low prealbumin (<15
mg/dL) indicates protein deficiency.
9. A diabetic patient reports hypoglycemia. Which food is best for rapid glucose replacement?
A) Peanut butter.
B) Orange juice.
C) Cheese crackers.
D) Eggs.
Answer: B
Explanation: Simple carbohydrates like juice raise blood glucose quickly. The “Rule of 15” (15 g
carbohydrate, recheck in 15 minutes) is standard for conscious hypoglycemia.
10. A client has cirrhosis of the liver. Which food should be limited?
A) Peanut butter.
B) Collard greens.
C) Eggs.
D) Wheat bread.
Answer: A
Explanation: Clients with cirrhosis have difficulty breaking down fat due to impaired bile synthesis.
Peanut butter is high in fat and should be limited.
11. A client with right upper quadrant pain after eating is likely reacting to which meal component?
A) Protein source.
B) Refined carbohydrates.
C) Saturated fat content.
D) Fresh, raw vegetables.
, Answer: C
Explanation: High-fat foods trigger cholecystokinin release, causing the gallbladder to contract. In
gallbladder disease, this can cause biliary colic.
12. A client is on warfarin (Coumadin) therapy. Which food should the nurse advise to eat
consistently?
A) Kale.
B) Broccoli.
C) Spinach.
D) Green beans.
Answer: D
Explanation: Warfarin is affected by vitamin K intake. Green beans have less vitamin K than kale,
broccoli, or spinach. Consistency is key — not avoidance.
13. A client with dysphagia is at risk for aspiration. Which intervention is most appropriate?
A) Provide thin liquids with meals.
B) Offer thickened liquids and small bites.
C) Encourage fast eating to finish meals.
D) Allow the client to eat lying flat in bed.
Answer: B
Explanation: Thickened liquids and small, manageable bites reduce risk of aspiration. Thin liquids flow
more quickly and are more dangerous.
14. Which laboratory value suggests protein-calorie malnutrition?
A) Albumin 3.8 g/dL.
B) Transferrin 90 mg/dL.
C) Total protein 6.2 g/dL.
D) Albumin 2.5 g/dL.
Answer: D
Explanation: Normal albumin is 3.5–5.0 g/dL. A low albumin level (<3.5) indicates chronic protein
deficiency, though prealbumin is a more acute marker.
15. A client with hypertension asks about low-sodium menu selections. Which choice indicates
understanding?
A) White rice and steamed vegetables with cottage cheese and sliced tomatoes.
B) Boiled lobster with baked potato.
(2026/2027): 300 Practice Questions with Rationales —
Comprehensive Review for RN Success"
.
Section 1: Therapeutic Diets & Disease Management (Questions 1–40)
1. A client with type 2 diabetes asks the nurse about lifestyle changes. Which information is most
important to reinforce?
A) Avoid all carbohydrates.
B) Portion-controlled, heart-healthy diet selections.
C) Eliminate all fats from the diet.
D) Focus on high-protein, low-carb only.
Answer: B
Explanation: A portion-controlled, heart-healthy diet helps manage blood glucose, lipids, and weight.
Complete avoidance of carbs or fats is not recommended; a balanced approach is key.
2. A client taking antibiotics develops diarrhea and has several small bruises. Which dietary change
should the nurse offer?
A) Reduced cholesterol and fats.
B) Potassium-rich fruits.
C) Increased proteins rich in iron.
D) Foods rich in vitamin K.
Answer: D
Explanation: Antibiotics can disrupt gut flora and reduce vitamin K synthesis. Bruising suggests vitamin K
deficiency, which is essential for clotting. Yogurt can help restore gut bacteria, but vitamin K foods (e.g.,
green leafy vegetables) are needed.
3. A vegan patient is at greatest risk for deficiency of which nutrient?
A) Vitamin C.
B) Vitamin B12.
C) Vitamin E.
D) Iron.
,Answer: B
Explanation: Vitamin B12 is found almost exclusively in animal products. Vegans require fortified foods
or supplements to prevent deficiency.
4. A client with heart failure is prescribed a low-sodium diet. Which menu choice is appropriate?
A) Canned soup.
B) Baked chicken.
C) Processed deli meats.
D) Canned olives.
Answer: B
Explanation: Fresh, unprocessed foods like baked chicken are naturally low in sodium. Canned,
processed, and pickled items are typically high in sodium.
5. A client with celiac disease asks for safe food options. Which food should the nurse recommend?
A) Barley soup.
B) Rye bread.
C) Corn tortillas.
D) Wheat pasta.
Answer: C
Explanation: Corn is naturally gluten-free. Barley, rye, and wheat all contain gluten and must be
avoided.
6. A pregnant client in her first trimester reports nausea. Which intervention is best?
A) Drink fluids with meals.
B) Eat dry crackers before rising.
C) Eat large meals instead of small ones.
D) Avoid all carbohydrates.
Answer: B
Explanation: Dry crackers before getting out of bed help reduce morning sickness by stabilizing gastric
acids. Small, frequent meals are also recommended.
7. An older adult with poor dentition needs increased calorie intake. Which food is most appropriate?
A) Raw carrots.
B) Steak strips.
C) Yogurt with fruit.
D) Whole almonds.
,Answer: C
Explanation: Soft, high-calorie foods support intake when chewing is difficult. Yogurt with fruit is
nutrient-dense and easy to eat.
8. Which lab value indicates protein malnutrition?
A) Sodium 145 mEq/L.
B) Glucose 90 mg/dL.
C) Prealbumin 8 mg/dL.
D) Potassium 4.2 mEq/L.
Answer: C
Explanation: Prealbumin has a short half-life and reflects acute protein status. Low prealbumin (<15
mg/dL) indicates protein deficiency.
9. A diabetic patient reports hypoglycemia. Which food is best for rapid glucose replacement?
A) Peanut butter.
B) Orange juice.
C) Cheese crackers.
D) Eggs.
Answer: B
Explanation: Simple carbohydrates like juice raise blood glucose quickly. The “Rule of 15” (15 g
carbohydrate, recheck in 15 minutes) is standard for conscious hypoglycemia.
10. A client has cirrhosis of the liver. Which food should be limited?
A) Peanut butter.
B) Collard greens.
C) Eggs.
D) Wheat bread.
Answer: A
Explanation: Clients with cirrhosis have difficulty breaking down fat due to impaired bile synthesis.
Peanut butter is high in fat and should be limited.
11. A client with right upper quadrant pain after eating is likely reacting to which meal component?
A) Protein source.
B) Refined carbohydrates.
C) Saturated fat content.
D) Fresh, raw vegetables.
, Answer: C
Explanation: High-fat foods trigger cholecystokinin release, causing the gallbladder to contract. In
gallbladder disease, this can cause biliary colic.
12. A client is on warfarin (Coumadin) therapy. Which food should the nurse advise to eat
consistently?
A) Kale.
B) Broccoli.
C) Spinach.
D) Green beans.
Answer: D
Explanation: Warfarin is affected by vitamin K intake. Green beans have less vitamin K than kale,
broccoli, or spinach. Consistency is key — not avoidance.
13. A client with dysphagia is at risk for aspiration. Which intervention is most appropriate?
A) Provide thin liquids with meals.
B) Offer thickened liquids and small bites.
C) Encourage fast eating to finish meals.
D) Allow the client to eat lying flat in bed.
Answer: B
Explanation: Thickened liquids and small, manageable bites reduce risk of aspiration. Thin liquids flow
more quickly and are more dangerous.
14. Which laboratory value suggests protein-calorie malnutrition?
A) Albumin 3.8 g/dL.
B) Transferrin 90 mg/dL.
C) Total protein 6.2 g/dL.
D) Albumin 2.5 g/dL.
Answer: D
Explanation: Normal albumin is 3.5–5.0 g/dL. A low albumin level (<3.5) indicates chronic protein
deficiency, though prealbumin is a more acute marker.
15. A client with hypertension asks about low-sodium menu selections. Which choice indicates
understanding?
A) White rice and steamed vegetables with cottage cheese and sliced tomatoes.
B) Boiled lobster with baked potato.
