PSU
Penn State University
152 • 3 MAXE
NURS College of Nursing — NURS 251 Exam 3
W E A R E · P E N N S TAT E
251
NURS 251 — Exam 3
N U T R I T I O N , M E TA B O L I S M , D I E TA R Y G U I D E L I N E S & E N T E R A L / PA R E N T E R A L S U P P O RT
INSTITUTION Penn State University EXAM CODE PSU-NURS251-EX3-2026
PROGRAM NURS 251 — Health Assessment ACADEMIC YEAR
EXAM TITLE NURS 251 Exam 3 — Nutrition & TOTAL QUESTIONS 30 Questions — Comprehensive Review
Metabolism
COURSE TITLE Health Assessment FORMAT Multiple Choice — Select the Single Best
Answer
EXAMINATION INSTRUCTIONS
▸ Select the single best answer for each question.
▸ Questions cover metabolism (catabolism, anabolism, BMR), nutritional assessment (BMI, albumin, prealbumin), dietary
guidelines across the lifespan, food safety, therapeutic diets, enteral and parenteral nutrition, and foodborne illness.
▸ Distinguish carefully between TPN and TEN, clear liquid vs. full liquid diets, and the nutritional needs of different age groups.
▸ Correct answers and detailed rationales appear below each question.
SECTION I — NUTRITION, METABOLISM & DIETARY THERAPEUTICS Questions 1 – 30
1. Metabolism is best defined as:
A. Only the process of breaking down food for energy
B. The body's chemical process that converts energy, builds substances, and removes waste to sustain life — includes
both catabolism and anabolism
C. The mechanical digestion of food in the stomach
D. The absorption of nutrients in the small intestine only
CORRECT ANSWER B — Metabolism encompasses ALL chemical processes: catabolism (breaking down macronutrients for
energy — e.g., glucose) AND anabolism (building complex molecules — e.g., protein synthesis during
healing).
RATIONALE Catabolism = destructive metabolism — breaks down complex substances into simpler ones, releasing energy
(glucose from glycogen, fatty acids from triglycerides). Anabolism = constructive metabolism — builds
complex molecules from simpler ones, requiring energy (protein synthesis, bone mineralization, muscle
growth). Basal Metabolic Rate (BMR) = energy required for involuntary functions (breathing, heartbeat,
circulation, temperature regulation) over 24 hours. BMR accounts for 60–75% of total energy expenditure.
, 2. Factors that INCREASE Basal Metabolic Rate (BMR) include all of the following EXCEPT:
A. Fever, infection, stress, burns, and extreme temperatures
B. Hyperthyroidism, cancer, rapid growth (infancy, puberty, pregnancy, lactation), high muscle mass, and male sex
C. Hypothyroidism — this DECREASES BMR by lowering metabolic demands
D. Wound healing and recovery from surgery
CORRECT ANSWER C — Hypothyroidism DECREASES BMR (lowers metabolic rate). Factors that INCREASE BMR:
hyperthyroidism, fever, infection, stress, burns, extreme temperatures, cancer, rapid growth periods,
pregnancy, lactation, high muscle mass, and male gender.
RATIONALE BMR is affected by: thyroid hormones (hyperthyroidism = increased; hypothyroidism = decreased), body
composition (more muscle = higher BMR; more fat = lower BMR), age (BMR decreases with age due to muscle
loss), gender (males have higher BMR due to more muscle mass), growth periods (infancy, puberty,
pregnancy), fever (BMR increases 7% per 1°F above normal), and stress/illness (trauma, burns, surgery,
infection). Starvation and fasting DECREASE BMR as the body conserves energy.
3. A BMI of 32 would be classified as:
A. Healthy weight (18.5–24.9)
B. Overweight (25–29.9)
C. Obese (>30) — 32 falls in the obese category
D. Extreme obesity (>35)
CORRECT ANSWER C — BMI 30+ = Obese. Classification: <18.5 = Underweight; 18.5–24.9 = Healthy; 25–29.9 = Overweight;
>30 = Obese; >35 = Extreme obesity.
RATIONALE BMI = weight (kg) ÷ height² (m²). Limitations: does not distinguish between muscle and fat; athletes may have
high BMI but low body fat. Waist circumference and Waist-to-Hip Ratio (WHR) are better indicators of
cardiovascular risk because they reflect abdominal adiposity (visceral fat). Apple-shaped body (central
obesity) = higher risk than pear-shaped (hip/thigh fat). Women: waist >35 inches = increased risk. Men: waist
>40 inches = increased risk.
4. Albumin and prealbumin are laboratory markers for nutritional status. Which statement is correct?
A. Albumin reflects short-term nutritional changes; prealbumin reflects long-term status
B. Albumin (normal 3.5–5.0 g/dL) reflects LONG-TERM nutritional status (half-life ~21 days); Prealbumin (normal 15–36
mg/dL) reflects SHORT-TERM/recent changes (half-life ~2 days) and is most sensitive to acute nutrition changes
C. Both albumin and prealbumin measure the same thing with the same sensitivity
D. Albumin is only useful for assessing hydration status
CORRECT ANSWER B — Albumin (half-life ~21 days) = LONG-TERM marker (reflects past 2–3 weeks). Prealbumin (half-life
~2 days) = SHORT-TERM marker, most sensitive to acute nutritional changes. Both decrease in
malnutrition.
RATIONALE Nutritional lab monitoring: Albumin <3.5 g/dL indicates protein depletion — associated with poor wound
healing, increased infection risk, and pressure injury development. Prealbumin is preferred for monitoring
nutritional repletion because it responds within days to improved intake. Other indicators: nitrogen balance
(neutral = intake = output; positive = anabolism/growth/healing; negative = catabolism/stress/starvation),
total lymphocyte count, and transferrin. Weight trends and dietary intake history complement lab values.
Penn State University
152 • 3 MAXE
NURS College of Nursing — NURS 251 Exam 3
W E A R E · P E N N S TAT E
251
NURS 251 — Exam 3
N U T R I T I O N , M E TA B O L I S M , D I E TA R Y G U I D E L I N E S & E N T E R A L / PA R E N T E R A L S U P P O RT
INSTITUTION Penn State University EXAM CODE PSU-NURS251-EX3-2026
PROGRAM NURS 251 — Health Assessment ACADEMIC YEAR
EXAM TITLE NURS 251 Exam 3 — Nutrition & TOTAL QUESTIONS 30 Questions — Comprehensive Review
Metabolism
COURSE TITLE Health Assessment FORMAT Multiple Choice — Select the Single Best
Answer
EXAMINATION INSTRUCTIONS
▸ Select the single best answer for each question.
▸ Questions cover metabolism (catabolism, anabolism, BMR), nutritional assessment (BMI, albumin, prealbumin), dietary
guidelines across the lifespan, food safety, therapeutic diets, enteral and parenteral nutrition, and foodborne illness.
▸ Distinguish carefully between TPN and TEN, clear liquid vs. full liquid diets, and the nutritional needs of different age groups.
▸ Correct answers and detailed rationales appear below each question.
SECTION I — NUTRITION, METABOLISM & DIETARY THERAPEUTICS Questions 1 – 30
1. Metabolism is best defined as:
A. Only the process of breaking down food for energy
B. The body's chemical process that converts energy, builds substances, and removes waste to sustain life — includes
both catabolism and anabolism
C. The mechanical digestion of food in the stomach
D. The absorption of nutrients in the small intestine only
CORRECT ANSWER B — Metabolism encompasses ALL chemical processes: catabolism (breaking down macronutrients for
energy — e.g., glucose) AND anabolism (building complex molecules — e.g., protein synthesis during
healing).
RATIONALE Catabolism = destructive metabolism — breaks down complex substances into simpler ones, releasing energy
(glucose from glycogen, fatty acids from triglycerides). Anabolism = constructive metabolism — builds
complex molecules from simpler ones, requiring energy (protein synthesis, bone mineralization, muscle
growth). Basal Metabolic Rate (BMR) = energy required for involuntary functions (breathing, heartbeat,
circulation, temperature regulation) over 24 hours. BMR accounts for 60–75% of total energy expenditure.
, 2. Factors that INCREASE Basal Metabolic Rate (BMR) include all of the following EXCEPT:
A. Fever, infection, stress, burns, and extreme temperatures
B. Hyperthyroidism, cancer, rapid growth (infancy, puberty, pregnancy, lactation), high muscle mass, and male sex
C. Hypothyroidism — this DECREASES BMR by lowering metabolic demands
D. Wound healing and recovery from surgery
CORRECT ANSWER C — Hypothyroidism DECREASES BMR (lowers metabolic rate). Factors that INCREASE BMR:
hyperthyroidism, fever, infection, stress, burns, extreme temperatures, cancer, rapid growth periods,
pregnancy, lactation, high muscle mass, and male gender.
RATIONALE BMR is affected by: thyroid hormones (hyperthyroidism = increased; hypothyroidism = decreased), body
composition (more muscle = higher BMR; more fat = lower BMR), age (BMR decreases with age due to muscle
loss), gender (males have higher BMR due to more muscle mass), growth periods (infancy, puberty,
pregnancy), fever (BMR increases 7% per 1°F above normal), and stress/illness (trauma, burns, surgery,
infection). Starvation and fasting DECREASE BMR as the body conserves energy.
3. A BMI of 32 would be classified as:
A. Healthy weight (18.5–24.9)
B. Overweight (25–29.9)
C. Obese (>30) — 32 falls in the obese category
D. Extreme obesity (>35)
CORRECT ANSWER C — BMI 30+ = Obese. Classification: <18.5 = Underweight; 18.5–24.9 = Healthy; 25–29.9 = Overweight;
>30 = Obese; >35 = Extreme obesity.
RATIONALE BMI = weight (kg) ÷ height² (m²). Limitations: does not distinguish between muscle and fat; athletes may have
high BMI but low body fat. Waist circumference and Waist-to-Hip Ratio (WHR) are better indicators of
cardiovascular risk because they reflect abdominal adiposity (visceral fat). Apple-shaped body (central
obesity) = higher risk than pear-shaped (hip/thigh fat). Women: waist >35 inches = increased risk. Men: waist
>40 inches = increased risk.
4. Albumin and prealbumin are laboratory markers for nutritional status. Which statement is correct?
A. Albumin reflects short-term nutritional changes; prealbumin reflects long-term status
B. Albumin (normal 3.5–5.0 g/dL) reflects LONG-TERM nutritional status (half-life ~21 days); Prealbumin (normal 15–36
mg/dL) reflects SHORT-TERM/recent changes (half-life ~2 days) and is most sensitive to acute nutrition changes
C. Both albumin and prealbumin measure the same thing with the same sensitivity
D. Albumin is only useful for assessing hydration status
CORRECT ANSWER B — Albumin (half-life ~21 days) = LONG-TERM marker (reflects past 2–3 weeks). Prealbumin (half-life
~2 days) = SHORT-TERM marker, most sensitive to acute nutritional changes. Both decrease in
malnutrition.
RATIONALE Nutritional lab monitoring: Albumin <3.5 g/dL indicates protein depletion — associated with poor wound
healing, increased infection risk, and pressure injury development. Prealbumin is preferred for monitoring
nutritional repletion because it responds within days to improved intake. Other indicators: nitrogen balance
(neutral = intake = output; positive = anabolism/growth/healing; negative = catabolism/stress/starvation),
total lymphocyte count, and transferrin. Weight trends and dietary intake history complement lab values.
