NR 228 / NR228 Exam 1 Nutrition Health
and Wellness ACTUAL EXAM 2026/2027
NR 228 Nutrition Exam 1 | Verified Q&A
Pass Guaranteed - A+ Graded
Section 1: Basic Nutrition Principles & Macronutrients (Q1–Q12)
Q1: A 72-year-old patient is prescribed furosemide, a loop diuretic. The nurse should monitor for
deficiency of which electrolyte?
A. Calcium
B. Potassium [CORRECT]
C. Sodium
D. Chloride
Correct Answer: B
Rationale: Furosemide is a loop diuretic that inhibits the Na⁺-K⁺-2Cl⁻ cotransporter in the thick
ascending limb of the Loop of Henle, causing increased excretion of sodium, chloride, and water.
However, it also increases potassium excretion because the increased distal tubular flow and sodium
delivery stimulate aldosterone-mediated potassium secretion. Hypokalemia (K⁺ <3.5 mEq/L) is the most
common electrolyte disturbance with loop diuretics, potentially causing cardiac arrhythmias, muscle
weakness, and fatigue. Nurses must monitor serum potassium, encourage potassium-rich foods
(bananas, oranges, potatoes, spinach), and administer potassium supplements or potassium-sparing
diuretics as ordered.
Q2: Which macronutrient provides the most calories per gram?
A. Carbohydrate
B. Protein
C. Fat [CORRECT]
D. Water
,Correct Answer: C
Rationale: Fats (lipids) provide 9 calories per gram, compared to 4 calories per gram for carbohydrates
and proteins, and 0 calories for water, vitamins, and minerals. This higher caloric density reflects the
greater oxidation state of fatty acids and their role in long-term energy storage. Dietary fats are
essential for absorption of fat-soluble vitamins (A, D, E, K), hormone synthesis, cell membrane structure,
and provision of essential fatty acids (linoleic acid, alpha-linolenic acid) that the body cannot synthesize.
While fats are energy-dense, the Dietary Guidelines for Americans recommend limiting saturated and
trans fats and emphasizing unsaturated fats for cardiovascular health.
Q3: A patient with celiac disease must avoid which protein found in wheat, barley, and rye?
A. Casein
B. Gluten [CORRECT]
C. Lactalbumin
D. Albumin
Correct Answer: B
Rationale: Gluten is a composite protein formed from gliadin and glutenin, found in wheat, barley, rye,
and their derivatives. In celiac disease, an autoimmune disorder, gluten ingestion triggers an immune-
mediated inflammatory response that damages the villi of the small intestine, leading to malabsorption
of nutrients, diarrhea, weight loss, and nutritional deficiencies. Strict lifelong avoidance of gluten is the
only treatment. Casein is a milk protein; lactalbumin is a whey protein in milk; albumin is a serum
protein. Patients with celiac disease must also monitor for cross-contamination and hidden gluten in
processed foods, medications, and cosmetics.
Q4: Which type of carbohydrate is broken down most slowly, providing sustained energy and promoting
satiety?
A. Simple sugars (glucose, fructose)
B. Complex carbohydrates and dietary fiber [CORRECT]
C. Refined grains (white bread, white rice)
D. High-fructose corn syrup
Correct Answer: B
Rationale: Complex carbohydrates (starches in whole grains, legumes, vegetables) and dietary fiber
(soluble and insoluble) require enzymatic breakdown and mechanical processing in the digestive tract,
resulting in slower glucose absorption, lower glycemic response, and sustained energy release. Fiber
adds bulk, slows gastric emptying, and promotes satiety through mechanical distension and hormonal
, signals (GLP-1, PYY). Simple sugars and refined grains are rapidly absorbed, causing blood glucose spikes
and crashes. The Dietary Guidelines recommend that at least half of grain intake be whole grains, and
adults consume 25–38 grams of fiber daily for digestive health, glycemic control, and cardiovascular risk
reduction.
Q5: Which amino acid classification describes a protein that contains all nine essential amino acids in
adequate proportions?
A. Incomplete protein
B. Complete protein [CORRECT]
C. Nonessential protein
D. Complementary protein
Correct Answer: B
Rationale: Complete proteins contain all nine essential amino acids (histidine, isoleucine, leucine, lysine,
methionine, phenylalanine, threonine, tryptophan, valine) in proportions sufficient to support protein
synthesis and nitrogen balance. Animal sources (meat, poultry, fish, eggs, dairy) and soy provide
complete proteins. Incomplete proteins lack one or more essential amino acids or have them in
insufficient proportions; most plant proteins (legumes, grains, nuts, seeds) are incomplete.
Complementary proteins are combinations of incomplete proteins (rice + beans, hummus + pita) that
together provide all essential amino acids. Nonessential amino acids (alanine, asparagine, aspartic acid,
glutamic acid) can be synthesized by the body and are not required in the diet.
Q6: The thermic effect of food (TEF) refers to:
A. The energy required to digest, absorb, transport, metabolize, and store nutrients, representing
approximately 10% of total daily energy expenditure [CORRECT]
B. The energy expended during sleep
C. The energy required for physical activity
D. The energy stored as adipose tissue
Correct Answer: A
Rationale: The thermic effect of food (also called diet-induced thermogenesis or specific dynamic
action) is the energy expended for the processing of food, including digestion, absorption, transport,
metabolism, and storage of nutrients. It accounts for approximately 10% of total daily energy
expenditure. Protein has the highest TEF (20–30% of its energy content), followed by carbohydrates (5–
10%), and fats (0–3%). This partially explains why high-protein diets may support weight management.
Basal metabolic rate (BMR) accounts for 60–75% of energy expenditure; physical activity accounts for
15–30%; TEF is the smallest component but is influenced by meal size, composition, and frequency.
and Wellness ACTUAL EXAM 2026/2027
NR 228 Nutrition Exam 1 | Verified Q&A
Pass Guaranteed - A+ Graded
Section 1: Basic Nutrition Principles & Macronutrients (Q1–Q12)
Q1: A 72-year-old patient is prescribed furosemide, a loop diuretic. The nurse should monitor for
deficiency of which electrolyte?
A. Calcium
B. Potassium [CORRECT]
C. Sodium
D. Chloride
Correct Answer: B
Rationale: Furosemide is a loop diuretic that inhibits the Na⁺-K⁺-2Cl⁻ cotransporter in the thick
ascending limb of the Loop of Henle, causing increased excretion of sodium, chloride, and water.
However, it also increases potassium excretion because the increased distal tubular flow and sodium
delivery stimulate aldosterone-mediated potassium secretion. Hypokalemia (K⁺ <3.5 mEq/L) is the most
common electrolyte disturbance with loop diuretics, potentially causing cardiac arrhythmias, muscle
weakness, and fatigue. Nurses must monitor serum potassium, encourage potassium-rich foods
(bananas, oranges, potatoes, spinach), and administer potassium supplements or potassium-sparing
diuretics as ordered.
Q2: Which macronutrient provides the most calories per gram?
A. Carbohydrate
B. Protein
C. Fat [CORRECT]
D. Water
,Correct Answer: C
Rationale: Fats (lipids) provide 9 calories per gram, compared to 4 calories per gram for carbohydrates
and proteins, and 0 calories for water, vitamins, and minerals. This higher caloric density reflects the
greater oxidation state of fatty acids and their role in long-term energy storage. Dietary fats are
essential for absorption of fat-soluble vitamins (A, D, E, K), hormone synthesis, cell membrane structure,
and provision of essential fatty acids (linoleic acid, alpha-linolenic acid) that the body cannot synthesize.
While fats are energy-dense, the Dietary Guidelines for Americans recommend limiting saturated and
trans fats and emphasizing unsaturated fats for cardiovascular health.
Q3: A patient with celiac disease must avoid which protein found in wheat, barley, and rye?
A. Casein
B. Gluten [CORRECT]
C. Lactalbumin
D. Albumin
Correct Answer: B
Rationale: Gluten is a composite protein formed from gliadin and glutenin, found in wheat, barley, rye,
and their derivatives. In celiac disease, an autoimmune disorder, gluten ingestion triggers an immune-
mediated inflammatory response that damages the villi of the small intestine, leading to malabsorption
of nutrients, diarrhea, weight loss, and nutritional deficiencies. Strict lifelong avoidance of gluten is the
only treatment. Casein is a milk protein; lactalbumin is a whey protein in milk; albumin is a serum
protein. Patients with celiac disease must also monitor for cross-contamination and hidden gluten in
processed foods, medications, and cosmetics.
Q4: Which type of carbohydrate is broken down most slowly, providing sustained energy and promoting
satiety?
A. Simple sugars (glucose, fructose)
B. Complex carbohydrates and dietary fiber [CORRECT]
C. Refined grains (white bread, white rice)
D. High-fructose corn syrup
Correct Answer: B
Rationale: Complex carbohydrates (starches in whole grains, legumes, vegetables) and dietary fiber
(soluble and insoluble) require enzymatic breakdown and mechanical processing in the digestive tract,
resulting in slower glucose absorption, lower glycemic response, and sustained energy release. Fiber
adds bulk, slows gastric emptying, and promotes satiety through mechanical distension and hormonal
, signals (GLP-1, PYY). Simple sugars and refined grains are rapidly absorbed, causing blood glucose spikes
and crashes. The Dietary Guidelines recommend that at least half of grain intake be whole grains, and
adults consume 25–38 grams of fiber daily for digestive health, glycemic control, and cardiovascular risk
reduction.
Q5: Which amino acid classification describes a protein that contains all nine essential amino acids in
adequate proportions?
A. Incomplete protein
B. Complete protein [CORRECT]
C. Nonessential protein
D. Complementary protein
Correct Answer: B
Rationale: Complete proteins contain all nine essential amino acids (histidine, isoleucine, leucine, lysine,
methionine, phenylalanine, threonine, tryptophan, valine) in proportions sufficient to support protein
synthesis and nitrogen balance. Animal sources (meat, poultry, fish, eggs, dairy) and soy provide
complete proteins. Incomplete proteins lack one or more essential amino acids or have them in
insufficient proportions; most plant proteins (legumes, grains, nuts, seeds) are incomplete.
Complementary proteins are combinations of incomplete proteins (rice + beans, hummus + pita) that
together provide all essential amino acids. Nonessential amino acids (alanine, asparagine, aspartic acid,
glutamic acid) can be synthesized by the body and are not required in the diet.
Q6: The thermic effect of food (TEF) refers to:
A. The energy required to digest, absorb, transport, metabolize, and store nutrients, representing
approximately 10% of total daily energy expenditure [CORRECT]
B. The energy expended during sleep
C. The energy required for physical activity
D. The energy stored as adipose tissue
Correct Answer: A
Rationale: The thermic effect of food (also called diet-induced thermogenesis or specific dynamic
action) is the energy expended for the processing of food, including digestion, absorption, transport,
metabolism, and storage of nutrients. It accounts for approximately 10% of total daily energy
expenditure. Protein has the highest TEF (20–30% of its energy content), followed by carbohydrates (5–
10%), and fats (0–3%). This partially explains why high-protein diets may support weight management.
Basal metabolic rate (BMR) accounts for 60–75% of energy expenditure; physical activity accounts for
15–30%; TEF is the smallest component but is influenced by meal size, composition, and frequency.
