Nutrition & oral hydration NCLEX-RN Practice Questions

Nutrition & Oral Hydration NCLEX-RN Practice Questions focus on practical, patient-centered skills from the Basic Care & Comfort domain that every nurse must master. This topic explores safe feeding practices, dietary modifications for specific conditions, oral hydration strategies, and accurate intake and output management—skills critical for preventing complications like aspiration, electrolyte imbalances, and dehydration. The questions below simulate real NCLEX-style scenarios and emphasize evidence-based nursing interventions, interdisciplinary collaboration, and clinical judgment. Whether caring for patients with dysphagia, those on enteral or parenteral nutrition, or clients requiring fluid restrictions, these items will help you refine understanding, prioritize actions, and apply safe nutritional care plans with precision. Ideal for advanced learners seeking depth and exam readiness.

Q1. A post-stroke older adult with moderate oropharyngeal dysphagia is beginning oral intake. Which nursing intervention best reduces aspiration risk during hydration and feeding?

• Provide thin liquids with a straw to facilitate swallowing
• Provide thickened liquids and instruct the client to use a chin-tuck with each swallow
• Offer large sips to reduce fatigue and complete meals faster
• Encourage head extension during swallowing to open the airway

Correct Answer: Provide thickened liquids and instruct the client to use a chin-tuck with each swallow

Q2. A client’s total parenteral nutrition (TPN) bag will be empty before the next bag is available from pharmacy. What is the nurse’s best action?

• Stop the infusion and keep the line open with normal saline
• Hang 10% dextrose in water (D10W) at the same rate until TPN is available
• Reduce the rate by half until the next bag arrives
• Switch to lactated Ringer’s to maintain osmolarity

Correct Answer: Hang 10% dextrose in water (D10W) at the same rate until TPN is available

Q3. Over an 8-hour shift, a client’s intake/output is: IV NS at 125 mL/hr, oral fluids 360 mL, tube flushes 60 mL. Outputs: urine 950 mL, emesis 200 mL, diarrhea 150 mL. What is the net fluid balance?

• +280 mL
• +120 mL
• -120 mL
• +220 mL

Correct Answer: +120 mL

Q4. Which food should be avoided in a client with heart failure on a 2-gram sodium diet?

• Fresh apple
• Grilled chicken breast seasoned with herbs
• Canned soup
• Unsalted brown rice

Correct Answer: Canned soup

Q5. A client with end-stage renal disease is on a 1,000 mL/day fluid restriction. Which strategy best helps control thirst while maintaining safety?

• Offer ice chips freely because they are not counted as intake
• Provide frequent oral care and offer ice chips while counting them toward the daily allowance
• Encourage sipping carbonated beverages to decrease thirst
• Increase salt intake to stimulate fluid retention

Correct Answer: Provide frequent oral care and offer ice chips while counting them toward the daily allowance

Q6. During gastric tube feeding, residual volume measured is 550 mL. The client has abdominal distention. What is the priority action?

• Continue the feeding and recheck residuals at the next scheduled time
• Hold the feeding, assess the client, and notify the provider of residual >500 mL
• Decrease the rate by half and position the client supine
• Administer additional free-water flushes to clear residuals

Correct Answer: Hold the feeding, assess the client, and notify the provider of residual >500 mL

Q7. An adult with mild dehydration from viral gastroenteritis asks what to drink at home. Which is the most appropriate advice?

• Use an oral rehydration solution in small, frequent sips
• Drink only plain water until symptoms resolve
• Use undiluted fruit juice to replace potassium
• Drink caffeinated tea to stimulate diuresis

Correct Answer: Use an oral rehydration solution in small, frequent sips

Q8. In older adults, which finding is an early and reliable indicator of dehydration status?

• Poor skin turgor on the hand
• Dry oral mucous membranes
• Sunken eyes
• Cool extremities

Correct Answer: Dry oral mucous membranes

Q9. A client on furosemide therapy requires dietary reinforcement. Which instruction is appropriate if not contraindicated?

• “Avoid potassium-rich foods to prevent hyperkalemia.”
• “Increase intake of potassium-rich foods like bananas and spinach.”
• “Restrict all fluids to prevent hyponatremia.”
• “Avoid magnesium-containing foods.”

Correct Answer: “Increase intake of potassium-rich foods like bananas and spinach.”

Q10. Which food selection demonstrates appropriate teaching for a client with celiac disease?

• Whole wheat toast and barley soup
• Grilled chicken, steamed vegetables, and brown rice
• Rye bread with butter and milk
• Oatmeal with raisins (unlabeled)

Correct Answer: Grilled chicken, steamed vegetables, and brown rice

Q11. A severely malnourished client is started on enteral feeding. Which laboratory value is most critical to monitor for refeeding syndrome?

• Serum phosphorus
• Serum calcium
• Serum triglycerides
• Serum bilirubin

Correct Answer: Serum phosphorus

Q12. A client receiving chemotherapy reports nausea affecting fluid intake. Which nursing intervention is best?

• Offer small, frequent sips of cool, clear liquids and administer antiemetics before meals
• Encourage spicy foods to stimulate appetite
• Provide large-volume fluids with meals
• Restrict fluids until nausea resolves

Correct Answer: Offer small, frequent sips of cool, clear liquids and administer antiemetics before meals

Q13. After bowel surgery, the client has return of bowel sounds and passes flatus. Which diet progression is most appropriate?

• Regular diet immediately
• Clear liquids, then full liquids, then soft, then regular as tolerated
• Full liquids, then regular diet
• NPO for 72 hours regardless of bowel sounds

Correct Answer: Clear liquids, then full liquids, then soft, then regular as tolerated

Q14. A client has documented silent aspiration of thin liquids. What is the most appropriate nursing action regarding hydration?

• Provide thin liquids with a straw for ease of intake
• Consult speech-language pathology and implement prescribed thickened liquids using standardized testing (e.g., IDDSI)
• Eliminate oral fluids and switch to IV fluids
• Offer carbonated beverages to increase sensory input

Correct Answer: Consult speech-language pathology and implement prescribed thickened liquids using standardized testing (e.g., IDDSI)

Q15. Which meal is most appropriate for a client with Crohn’s disease during an acute flare on a low-residue diet?

• Raw salad, nuts, and whole-grain bread
• Skinless baked chicken, white rice, and canned peaches
• Bean chili and corn on the cob
• Popcorn and a fresh apple with peel

Correct Answer: Skinless baked chicken, white rice, and canned peaches

Q16. A client on TPN develops dyspnea, crackles, and 3+ edema. What is the nurse’s first action?

• Increase the rate of TPN to complete the bag sooner
• Slow the infusion rate and elevate the head of the bed while reassessing respiratory status
• Discontinue TPN and remove the central line
• Place the client flat and encourage deep breathing

Correct Answer: Slow the infusion rate and elevate the head of the bed while reassessing respiratory status

Q17. Which item counts toward a client’s fluid intake on a strict intake and output record?

• Gelatin dessert
• Slice of bread
• Peanut butter
• Baked potato

Correct Answer: Gelatin dessert

Q18. Teaching for iron-deficiency anemia is effective when the client states:

• “I will take my iron pill with milk to protect my stomach.”
• “I will take ferrous sulfate with orange juice and avoid taking it with calcium.”
• “I will crush enteric-coated tablets for faster absorption.”
• “I will stop taking iron if my stools turn dark.”

Correct Answer: “I will take ferrous sulfate with orange juice and avoid taking it with calcium.”

Q19. To reduce aspiration risk with continuous gastric tube feeding, which intervention is essential?

• Position the client supine to enhance comfort
• Maintain head-of-bed elevation at 30–45 degrees during feeding and for at least 30–60 minutes afterward
• Stop all water flushes
• Use blue dye to detect aspiration

Correct Answer: Maintain head-of-bed elevation at 30–45 degrees during feeding and for at least 30–60 minutes afterward

Q20. A client with painful oral candidiasis is struggling with hydration. Which intervention is best?

• Offer acidic juices to numb the area
• Offer cool, bland liquids and provide gentle oral care before meals
• Encourage hot tea with lemon
• Use alcohol-based mouthwash before each sip

Correct Answer: Offer cool, bland liquids and provide gentle oral care before meals

Q21. Which food should be limited for a client with chronic kidney disease and hyperkalemia risk?

• White rice
• Baked potato
• Apple slices
• White bread

Correct Answer: Baked potato

Q22. A client with lactose intolerance needs to maintain calcium intake. Which choice is most appropriate?

• Lactose-free milk or calcium-fortified soy/almond milk
• Whole milk with added sugar
• Ice cream as the primary calcium source
• Unlabeled yogurt without checking tolerance

Correct Answer: Lactose-free milk or calcium-fortified soy/almond milk

Q23. For a client with a Stage II pressure injury, which snack best supports wound healing?

• Greek yogurt with berries
• Celery sticks
• Plain gelatin
• Unsalted crackers

Correct Answer: Greek yogurt with berries

Q24. A client with SIADH is on an 800 mL/day fluid restriction. Which strategy best promotes adherence?

• Provide all 800 mL at breakfast to ensure completion
• Divide the total into small, labeled containers for use throughout the day and use ice chips strategically
• Allow unlimited fluids if the client is thirsty
• Replace water with caffeinated beverages

Correct Answer: Divide the total into small, labeled containers for use throughout the day and use ice chips strategically

Q25. A severely malnourished client with chronic alcohol use is about to start high-calorie feeding. Which order should the nurse anticipate to prevent complications?

• High-dose insulin before feeding
• Thiamine supplementation before and during nutrition initiation
• Loop diuretic to prevent fluid shifts
• High sodium loading to maintain intravascular volume

Correct Answer: Thiamine supplementation before and during nutrition initiation

Q26. In counseling on oral rehydration, which statement is most accurate?

• “Plain water is sufficient for all dehydration.”
• “Use an oral rehydration solution containing balanced glucose and electrolytes.”
• “Undiluted fruit juice is preferred due to potassium content.”
• “Caffeinated beverages prevent dehydration.”

Correct Answer: “Use an oral rehydration solution containing balanced glucose and electrolytes.”

Q27. Post-bariatric surgery client education should include which instruction related to fluids and meals?

• Drink fluids with meals to aid swallowing
• Avoid liquids entirely for the first 2 weeks
• Avoid drinking fluids with meals; take small sips of sugar-free clear liquids between meals as tolerated
• Use straws to increase intake

Correct Answer: Avoid drinking fluids with meals; take small sips of sugar-free clear liquids between meals as tolerated

Q28. A client with 25% total body surface area burns requires high-protein, high-calorie nutrition. Which menu best supports this need?

• Eggs for breakfast, Greek yogurt snack, and a peanut butter smoothie
• Garden salad and fruit-only meals
• Plain broth and crackers for all meals
• Low-protein, low-fat diet to reduce metabolic demand

Correct Answer: Eggs for breakfast, Greek yogurt snack, and a peanut butter smoothie

Q29. An alert client with mild hypernatremia due to inadequate intake asks how to correct it safely. Which instruction is best?

• “Increase sodium intake to balance levels.”
• “Encourage oral free water intake and limit high-sodium foods.”
• “Avoid all fluids until sodium normalizes.”
• “Drink only high-sugar beverages.”

Correct Answer: “Encourage oral free water intake and limit high-sodium foods.”

Q30. A client’s nasogastric feeding tube is sluggish and suspected clogged. What is the best initial nursing action?

• Instill cola until the tube clears
• Flush with warm water using a gentle push-pull technique per policy
• Use a wire to mechanically dislodge the clog
• Increase feeding rate to force the clog through

Correct Answer: Flush with warm water using a gentle push-pull technique per policy

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