NCLEX-PN Test #15 3 — Questions and Answers
Question 1: A client with chronic kidney disease (stage 4) is placed on a renal diet. Which combination of foods is appropriate for this diet?
- Orange juice, banana, and whole wheat toast
- White rice, apple, and small portion of chicken (no added salt) (Correct answer)
- Tomato soup, spinach salad, and bran muffin
- Milk, yogurt, and almonds
Correct answer: White rice, apple, and small portion of chicken (no added salt)
The renal diet restricts potassium (no bananas, oranges, tomatoes, potatoes, spinach), phosphorus (limit dairy, nuts, whole grains), sodium, and often protein and fluid. White rice, apples, and small portions of lean protein with no added salt meet renal diet restrictions. Dairy (high phosphorus), spinach (high potassium), and oranges (high potassium) are restricted.
Question 2: A client recovering from a myocardial infarction is being counseled on a heart-healthy diet. Which dietary change has the greatest impact on reducing LDL cholesterol?
- Reducing total fat intake to less than 20% of total calories
- Replacing saturated and trans fats with unsaturated fats and increasing soluble fiber (Correct answer)
- Eliminating all dietary cholesterol (egg yolks, shellfish, organ meats)
- Increasing omega-3 supplementation to 3,000 mg daily
Correct answer: Replacing saturated and trans fats with unsaturated fats and increasing soluble fiber
Replacing saturated fats (found in red meat, butter, full-fat dairy) and trans fats with unsaturated fats (olive oil, nuts, avocado) and increasing soluble fiber (oats, legumes, apples) has the most evidence-based impact on reducing LDL cholesterol. Dietary cholesterol restriction has less impact on serum cholesterol than saturated fat reduction.
Question 3: The nurse is caring for a post-operative client with a nasogastric tube. Tube feedings are running. Which position best prevents aspiration?
- Supine (flat) to allow gravity to pull feedings toward the stomach
- Head of bed elevated 30–45 degrees (Correct answer)
- Semi-Fowler's position at 15 degrees only during administration
- Trendelenburg position to improve gastric emptying
Correct answer: Head of bed elevated 30–45 degrees
Elevating the head of bed to 30–45 degrees (semi-Fowler's) during and for 30–60 minutes after tube feedings reduces aspiration risk by using gravity to facilitate gastric emptying and minimize reflux. Flat/supine and Trendelenburg positions dramatically increase aspiration risk.
Question 4: A client with iron-deficiency anemia is prescribed ferrous sulfate (iron supplement). Which food enhances iron absorption?
- Milk and calcium-rich dairy products
- Whole grain bread with high fiber content
- A glass of orange juice (vitamin C) (Correct answer)
- Green tea or coffee with the meal
Correct answer: A glass of orange juice (vitamin C)
Vitamin C (ascorbic acid) converts dietary non-heme iron (ferric to ferrous form), significantly enhancing intestinal absorption of iron. It should be taken at the same time as the iron supplement. Calcium, tannins (tea, coffee), and high-fiber foods inhibit iron absorption and should be avoided with iron supplementation.
Question 5: A client with celiac disease asks what foods must be permanently eliminated from their diet. Which food group must be strictly avoided?
- All grains including rice and corn
- Foods containing gluten: wheat, barley, and rye (Correct answer)
- All dairy products due to associated lactose intolerance
- High-fiber vegetables that irritate the intestinal lining
Correct answer: Foods containing gluten: wheat, barley, and rye
Celiac disease is an autoimmune condition triggered by gluten — a protein in wheat (including spelt, kamut), barley, and rye. Strict, lifelong elimination of these grains is the only treatment. Rice, corn, quinoa, and potatoes are safe. Some clients have secondary lactose intolerance during active disease, but not all require permanent dairy restriction.
Question 6: A client is prescribed a 2-gram sodium diet. Which client statement indicates correct understanding?
- "I can add salt at the table as long as I cook without salt."
- "I should avoid adding salt during cooking and at the table and check food labels for sodium content." (Correct answer)
- "Sodium-free and salt-free on a label mean the same thing."
- "Canned soups are fine as long as I choose reduced-sodium varieties."
Correct answer: "I should avoid adding salt during cooking and at the table and check food labels for sodium content."
A 2 g sodium diet requires eliminating added salt, avoiding high-sodium processed and canned foods, and reading food labels. "Sodium-free" means < 5 mg/serving; "reduced sodium" means 25% less sodium than the original — but reduced-sodium canned soups can still contain 400–600 mg/serving, which may exceed restrictions. All sodium sources must be limited.
NCLEX-PN Test #15 3
A client with chronic kidney disease (stage 4) is placed on a renal diet.
Which combination of foods is appropriate for this diet?