NR 228 Final Exam Nutrition Health and
Wellness Latest 2026/2027 75 Questions
ACTUAL EXAM 2026/2027 |
Chamberlain NR 228 Final | Verified
Q&A | Pass Guaranteed - A+ Graded
Section 1: Basic Nutrition Principles & Macronutrients (Q1–Q13)
Q1: A patient with chronic kidney disease has a potassium level of 6.2 mEq/L. Which food choice should
the nurse discourage?
A. Apples
B. White rice
C. Bananas [CORRECT]
D. White bread
Correct Answer: C
Rationale: Bananas are a high-potassium food, containing approximately 422 mg of potassium per
medium fruit. In chronic kidney disease with hyperkalemia (K⁺ >5.5 mEq/L), dietary potassium restriction
(typically 2,000–3,000 mg/day) is essential to prevent life-threatening cardiac arrhythmias. The nurse
should counsel the patient to avoid or limit high-potassium foods including bananas, oranges, tomatoes,
potatoes, spinach, avocados, and dried fruits. Apples, white rice, and white bread are lower-potassium
alternatives appropriate for a renal diet. This represents a direct application of pathophysiology-based
dietary modification in clinical nursing practice.
Q2: A patient is receiving enteral nutrition via nasogastric tube at 75 mL/hr continuous infusion. Four
hours after initiation, the nurse aspirates 250 mL of gastric residual volume (GRV). Which action is the
priority?
,A. Immediately stop the tube feeding and notify the provider.
B. Hold the feeding, reassess in 1 hour, and if residual remains elevated, notify the provider; consider
prokinetic agent or post-pyloric feeding. [CORRECT]
C. Increase the feeding rate to 100 mL/hr to overcome delayed gastric emptying.
D. Administer an antiemetic and continue feeding at current rate.
Correct Answer: B
Rationale: Gastric residual volume monitoring assesses tolerance of enteral feeding and aspiration risk.
While historical thresholds were strict (hold if GRV >200–500 mL), current ASPEN/SCCM guidelines
emphasize that isolated GRV elevations without other signs of intolerance (abdominal distension,
vomiting, diarrhea) do not mandate automatic feeding cessation. However, a GRV of 250 mL in a patient
receiving 75 mL/hr (potential return of >50% of hourly infusion) warrants holding the feeding,
reassessing gastric emptying, and evaluating for causes (medications, ileus, hyperglycemia, sepsis). If
residuals remain elevated, the provider may order metoclopramide or erythromycin (prokinetics) or
transition to post-pyloric feeding. Increasing the rate worsens gastric distension and aspiration risk.
Q3: A patient with marasmus presents with severe muscle wasting, loss of subcutaneous fat, and normal
serum albumin. A patient with kwashiorkor presents with edema, distended abdomen, and low serum
albumin. Which physiological distinction explains the albumin difference?
A. Marasmus involves adequate protein intake with calorie deficiency; kwashiorkor involves protein
deficiency with adequate calories.
B. Marasmus results from overall calorie and protein deficiency with catabolism of all tissues including
albumin for energy; kwashiorkor involves protein deficiency with carbohydrate intake that spares
albumin catabolism but causes hypoalbuminemia due to inadequate synthesis. [CORRECT]
C. Both conditions result from identical pathophysiology.
D. Albumin levels are irrelevant to distinguishing these conditions.
Correct Answer: B
Rationale: In marasmus, severe deficiency of both calories and protein leads to catabolism of all body
tissues—including muscle, fat, and visceral proteins like albumin—for energy. However, because the
process is gradual and comprehensive, albumin may be maintained at low-normal levels initially as the
body prioritizes essential functions. In kwashiorkor, protein deficiency occurs with relatively adequate
caloric intake (often from carbohydrates). Carbohydrates spare protein from energy use, but without
dietary protein, albumin synthesis is severely impaired, causing marked hypoalbuminemia, edema, and
fatty liver. The edema in kwashiorkor masks muscle wasting, creating the classic "plump" appearance
with thin limbs. This distinction is critical for treatment: marasmus requires gradual high-calorie, high-
protein refeeding; kwashiorkor requires high-protein, moderate-calorie refeeding to prevent refeeding
syndrome.
, Q4: A patient with anorexia nervosa is being refed after prolonged starvation. Which complication is the
nurse most vigilant for during the first week?
A. Hyperglycemia from excessive carbohydrate intake
B. Refeeding syndrome—hypophosphatemia, hypokalemia, hypomagnesemia, and fluid shifts that can
cause cardiac failure, respiratory failure, and death [CORRECT]
C. Hypernatremia from sodium overload
D. Vitamin A toxicity from supplementation
Correct Answer: B
Rationale: Refeeding syndrome is a potentially fatal metabolic complication that occurs when severely
malnourished patients are rapidly refed with carbohydrates after prolonged starvation. During
starvation, intracellular minerals (phosphate, potassium, magnesium) are depleted despite normal or
near-normal serum levels. With carbohydrate refeeding, insulin secretion stimulates cellular uptake of
glucose, phosphate, potassium, and magnesium, causing precipitous drops in serum levels.
Hypophosphatemia (<0.32 mmol/L or <1.0 mg/dL) is the hallmark and causes respiratory muscle
weakness, hemolysis, rhabdomyolysis, cardiac failure, and neurologic dysfunction. Prevention requires
starting nutrition at 10–20 kcal/kg/day, thiamine supplementation before carbohydrates, and aggressive
monitoring/replacement of phosphate, potassium, magnesium, and calcium for the first 3–7 days.
Q5: A patient with Type 2 diabetes is learning carbohydrate counting. Which concept is essential for the
nurse to teach?
A. All carbohydrates raise blood glucose equally regardless of type.
B. The glycemic index and glycemic load help predict blood glucose response; fiber-rich, complex
carbohydrates have lower glycemic impact than refined sugars and should be emphasized. [CORRECT]
C. Patients with diabetes should avoid all carbohydrates.
D. Protein and fat do not affect blood glucose and can be ignored in meal planning.
Correct Answer: B
Rationale: Carbohydrate counting for diabetes management requires understanding that not all
carbohydrates produce equivalent glycemic responses. The glycemic index (GI) measures how quickly a
carbohydrate food raises blood glucose compared to pure glucose; the glycemic load (GL) accounts for
both GI and serving size. High-fiber, complex carbohydrates (whole grains, legumes, non-starchy
vegetables) have lower GI/GL due to slower digestion and absorption, producing gradual glucose rises.
Refined carbohydrates and simple sugars have high GI/GL, causing rapid spikes. Teaching patients to
emphasize low-GI foods, pair carbohydrates with protein/fat (which slow absorption), and distribute
carbohydrates consistently throughout the day supports glycemic control. Complete carbohydrate
Wellness Latest 2026/2027 75 Questions
ACTUAL EXAM 2026/2027 |
Chamberlain NR 228 Final | Verified
Q&A | Pass Guaranteed - A+ Graded
Section 1: Basic Nutrition Principles & Macronutrients (Q1–Q13)
Q1: A patient with chronic kidney disease has a potassium level of 6.2 mEq/L. Which food choice should
the nurse discourage?
A. Apples
B. White rice
C. Bananas [CORRECT]
D. White bread
Correct Answer: C
Rationale: Bananas are a high-potassium food, containing approximately 422 mg of potassium per
medium fruit. In chronic kidney disease with hyperkalemia (K⁺ >5.5 mEq/L), dietary potassium restriction
(typically 2,000–3,000 mg/day) is essential to prevent life-threatening cardiac arrhythmias. The nurse
should counsel the patient to avoid or limit high-potassium foods including bananas, oranges, tomatoes,
potatoes, spinach, avocados, and dried fruits. Apples, white rice, and white bread are lower-potassium
alternatives appropriate for a renal diet. This represents a direct application of pathophysiology-based
dietary modification in clinical nursing practice.
Q2: A patient is receiving enteral nutrition via nasogastric tube at 75 mL/hr continuous infusion. Four
hours after initiation, the nurse aspirates 250 mL of gastric residual volume (GRV). Which action is the
priority?
,A. Immediately stop the tube feeding and notify the provider.
B. Hold the feeding, reassess in 1 hour, and if residual remains elevated, notify the provider; consider
prokinetic agent or post-pyloric feeding. [CORRECT]
C. Increase the feeding rate to 100 mL/hr to overcome delayed gastric emptying.
D. Administer an antiemetic and continue feeding at current rate.
Correct Answer: B
Rationale: Gastric residual volume monitoring assesses tolerance of enteral feeding and aspiration risk.
While historical thresholds were strict (hold if GRV >200–500 mL), current ASPEN/SCCM guidelines
emphasize that isolated GRV elevations without other signs of intolerance (abdominal distension,
vomiting, diarrhea) do not mandate automatic feeding cessation. However, a GRV of 250 mL in a patient
receiving 75 mL/hr (potential return of >50% of hourly infusion) warrants holding the feeding,
reassessing gastric emptying, and evaluating for causes (medications, ileus, hyperglycemia, sepsis). If
residuals remain elevated, the provider may order metoclopramide or erythromycin (prokinetics) or
transition to post-pyloric feeding. Increasing the rate worsens gastric distension and aspiration risk.
Q3: A patient with marasmus presents with severe muscle wasting, loss of subcutaneous fat, and normal
serum albumin. A patient with kwashiorkor presents with edema, distended abdomen, and low serum
albumin. Which physiological distinction explains the albumin difference?
A. Marasmus involves adequate protein intake with calorie deficiency; kwashiorkor involves protein
deficiency with adequate calories.
B. Marasmus results from overall calorie and protein deficiency with catabolism of all tissues including
albumin for energy; kwashiorkor involves protein deficiency with carbohydrate intake that spares
albumin catabolism but causes hypoalbuminemia due to inadequate synthesis. [CORRECT]
C. Both conditions result from identical pathophysiology.
D. Albumin levels are irrelevant to distinguishing these conditions.
Correct Answer: B
Rationale: In marasmus, severe deficiency of both calories and protein leads to catabolism of all body
tissues—including muscle, fat, and visceral proteins like albumin—for energy. However, because the
process is gradual and comprehensive, albumin may be maintained at low-normal levels initially as the
body prioritizes essential functions. In kwashiorkor, protein deficiency occurs with relatively adequate
caloric intake (often from carbohydrates). Carbohydrates spare protein from energy use, but without
dietary protein, albumin synthesis is severely impaired, causing marked hypoalbuminemia, edema, and
fatty liver. The edema in kwashiorkor masks muscle wasting, creating the classic "plump" appearance
with thin limbs. This distinction is critical for treatment: marasmus requires gradual high-calorie, high-
protein refeeding; kwashiorkor requires high-protein, moderate-calorie refeeding to prevent refeeding
syndrome.
, Q4: A patient with anorexia nervosa is being refed after prolonged starvation. Which complication is the
nurse most vigilant for during the first week?
A. Hyperglycemia from excessive carbohydrate intake
B. Refeeding syndrome—hypophosphatemia, hypokalemia, hypomagnesemia, and fluid shifts that can
cause cardiac failure, respiratory failure, and death [CORRECT]
C. Hypernatremia from sodium overload
D. Vitamin A toxicity from supplementation
Correct Answer: B
Rationale: Refeeding syndrome is a potentially fatal metabolic complication that occurs when severely
malnourished patients are rapidly refed with carbohydrates after prolonged starvation. During
starvation, intracellular minerals (phosphate, potassium, magnesium) are depleted despite normal or
near-normal serum levels. With carbohydrate refeeding, insulin secretion stimulates cellular uptake of
glucose, phosphate, potassium, and magnesium, causing precipitous drops in serum levels.
Hypophosphatemia (<0.32 mmol/L or <1.0 mg/dL) is the hallmark and causes respiratory muscle
weakness, hemolysis, rhabdomyolysis, cardiac failure, and neurologic dysfunction. Prevention requires
starting nutrition at 10–20 kcal/kg/day, thiamine supplementation before carbohydrates, and aggressive
monitoring/replacement of phosphate, potassium, magnesium, and calcium for the first 3–7 days.
Q5: A patient with Type 2 diabetes is learning carbohydrate counting. Which concept is essential for the
nurse to teach?
A. All carbohydrates raise blood glucose equally regardless of type.
B. The glycemic index and glycemic load help predict blood glucose response; fiber-rich, complex
carbohydrates have lower glycemic impact than refined sugars and should be emphasized. [CORRECT]
C. Patients with diabetes should avoid all carbohydrates.
D. Protein and fat do not affect blood glucose and can be ignored in meal planning.
Correct Answer: B
Rationale: Carbohydrate counting for diabetes management requires understanding that not all
carbohydrates produce equivalent glycemic responses. The glycemic index (GI) measures how quickly a
carbohydrate food raises blood glucose compared to pure glucose; the glycemic load (GL) accounts for
both GI and serving size. High-fiber, complex carbohydrates (whole grains, legumes, non-starchy
vegetables) have lower GI/GL due to slower digestion and absorption, producing gradual glucose rises.
Refined carbohydrates and simple sugars have high GI/GL, causing rapid spikes. Teaching patients to
emphasize low-GI foods, pair carbohydrates with protein/fat (which slow absorption), and distribute
carbohydrates consistently throughout the day supports glycemic control. Complete carbohydrate
