NMC CBT Nutrition and Fluid Balance 2 — Questions and Answers
Question 1: Before administering the first feed via a newly inserted nasogastric tube, which method is the GOLD STANDARD for confirming correct tube position?
- Aspirating gastric contents and checking colour
- Auscultating air insufflation over the epigastrium
- Checking pH of aspirate is 5.5 or below
- Confirming position with a chest X-ray (Correct answer)
Correct answer: Confirming position with a chest X-ray
A chest X-ray is the gold standard for confirming nasogastric tube position before the first feed, especially when pH aspirate is inconclusive.
Question 2: A patient develops signs of fluid overload. Which combination of findings is MOST consistent with this condition?
- Tachycardia, dry mucous membranes, and oliguria
- Hypertension, peripheral oedema, and bibasal crackles (Correct answer)
- Hypotension, poor skin turgor, and concentrated urine
- Bradycardia, weight loss, and sunken eyes
Correct answer: Hypertension, peripheral oedema, and bibasal crackles
Fluid overload presents with hypertension, dependent oedema, and pulmonary oedema signs such as bibasal crackles due to excess intravascular and interstitial fluid.
Question 3: A patient is prescribed Total Parenteral Nutrition (TPN). Which vascular access route is MOST appropriate for long-term TPN administration?
- Peripheral cannula in the forearm
- Central venous catheter (Correct answer)
- Intraosseous needle
- Arterial line
Correct answer: Central venous catheter
TPN is a hypertonic solution that must be administered via a central venous catheter to avoid peripheral vein damage and thrombophlebitis.
Question 4: Which laboratory marker is commonly used to assess a patient's long-term nutritional status and protein synthesis?
- Serum glucose
- Serum albumin (Correct answer)
- Serum creatinine
- C-reactive protein (CRP)
Correct answer: Serum albumin
Serum albumin reflects nutritional status over weeks as it is synthesised by the liver and has a half-life of approximately 20 days, indicating chronic protein adequacy.
Question 5: A patient with dysphagia is assessed by the speech and language therapy team and placed on a modified texture diet. According to the IDDSI framework, which descriptor refers to a smooth, cohesive food that requires no chewing?
- Minced and moist
- Soft and bite-sized
- Pureed (Correct answer)
- Regular
Correct answer: Pureed
IDDSI Level 4 (Pureed) describes food that is smooth, uniform, and cohesive with no lumps, requiring no chewing and suitable for patients with severe dysphagia.
Question 6: Which of the following conditions is MOST likely to cause hyponatraemia (low serum sodium)?
- Excessive IV saline infusion
- Syndrome of Inappropriate ADH Secretion (SIADH) (Correct answer)
- Diabetes insipidus
- Addison's disease treated with fludrocortisone
Correct answer: Syndrome of Inappropriate ADH Secretion (SIADH)
SIADH causes excessive retention of water relative to sodium, diluting serum sodium and resulting in hyponatraemia.
Question 7: A nurse is caring for a patient on fluid restriction of 1000 mL per day. The patient has already consumed 650 mL during the morning shift. How much fluid can the patient receive for the rest of the day?
- 250 mL
- 350 mL (Correct answer)
- 450 mL
- 500 mL
Correct answer: 350 mL
1000 mL total minus 650 mL already consumed equals 350 mL remaining for the rest of the day.
NMC CBT Nutrition and Fluid Balance 2
Before administering the first feed via a newly inserted nasogastric tube, which method is the GOLD STANDARD for confirming correct tube position?