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NCLEX nutrition and tube feeding practice questions

20 free NCLEX-style nutrition questions: therapeutic diets you must not mix up, NG tube placement, enteral feeds and aspiration prevention, each with the answer and rationale.

Tap an answer to check it, or open "Show the answer and rationale" under each question. Every client is fictional. For exam practice only, not medical advice.

Question 1 of 20

A client who had a stroke 5 days ago is eating lunch while sitting upright in a chair. The speech-language pathologist has prescribed pureed foods and mildly thick liquids. Which finding requires the nurse's immediate follow-up?

  1. The client's voice sounds wet and gurgly after sips of juice
  2. The client has eaten only half the meal after 30 minutes
  3. A small amount of food stays pocketed in the weak cheek
  4. The client takes a second, dry swallow after each bite
Show the answer and rationale

Answer: A

A wet, gurgly voice after swallowing means liquid has entered the larynx, a sign of laryngeal penetration or aspiration, so the nurse stops oral intake, has the client cough and clear the throat, and reports to the speech-language pathologist and provider before feeding resumes. Food pocketed in the weak cheek is the runner-up: the client needs a cue to clear it, but it is a risk, not evidence that material is already entering the airway. A second, dry swallow after each bite is a taught strategy that clears residue from the throat, and a slow meal calls for smaller, more frequent meals rather than urgent action.

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Question 2 of 20

A client is 1 day past a subtotal gastrectomy, and the nasogastric tube placed during surgery is connected to low intermittent suction. The nurse notes that the tube has drained nothing for the past 3 hours, and the client reports nausea and upper abdominal fullness. Which action should the nurse take?

  1. Switch the suction to continuous high to clear the blockage
  2. Notify the surgeon that the tube has stopped draining
  3. Irrigate the tube with 30 mL of normal saline to restore drainage
  4. Advance the tube 2 inches (5 cm) to reach pooled gastric fluid
Show the answer and rationale

Answer: B

A nasogastric tube placed during gastric or esophageal surgery lies near a fresh suture line, so it is not irrigated or repositioned unless the surgeon prescribes it; a tube that stops draining while the client becomes nauseated is reported so the surgeon can decide how to clear it before the stomach distends and strains the anastomosis. Irrigating with 30 mL of saline is the runner-up because it is the usual first step for a tube that stops draining after other surgery, but here it can disrupt the repair. Advancing the tube manipulates it against the suture line, and high continuous suction can pull the gastric lining into the tube's openings and injure it.

๐Ÿ“š Learn it: NG Tubes, Enteral Feeds and Keeping Food Out of Lungs

Question 3 of 20

A client who receives hemodialysis three times a week has a fluid allowance of 1,000 mL a day and has gained 3 kg (6.6 lb) since the last treatment. The client says, 'I'm thirsty all the time, so I can't stay under my limit.' Which instruction will best help the client control thirst?

  1. Chill part of your daily allowance as ice chips and suck them freely, since ice does not count toward the limit
  2. Drink a low-sodium sports drink when thirsty, since replacing electrolytes reduces the body's thirst signals
  3. Limit salty and processed foods, since sodium makes you thirstier
  4. Rinse several times a day with an alcohol-based mouthwash to keep your mouth feeling fresh and moist
Show the answer and rationale

Answer: C

Sodium triggers thirst, so cutting back on salty and processed foods is the most effective way to control thirst and the large weight gains between treatments; each extra kilogram is about a liter of retained fluid. Ice chips are the runner-up because ice lasts longer in the mouth and can help, but it melts to water and counts toward the 1,000 mL limit, so sucking it freely on top of the allowance defeats the plan. A sports drink, even a low-sodium one, still adds sodium and potassium that a client on dialysis must limit. Alcohol-based mouthwash dries the mouth and worsens thirst; sugar-free hard candy, gum, or a dry-mouth rinse works better.

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Question 4 of 20

A client with type 2 diabetes who is NPO because of dysphagia after a stroke receives continuous nasogastric feedings at 70 mL/hr. The client received the scheduled dose of NPH insulin at 0800. At 1000 the client pulls out the feeding tube, and the provider prescribes a new tube with x-ray confirmation of placement before the feeding restarts. Which action should the nurse take first?

  1. Hold the next scheduled NPH dose until the feeding restarts
  2. Insert a new tube now so the feeding can restart within the hour
  3. Give 4 oz (120 mL) of juice by mouth to replace the carbohydrate
  4. Check the blood glucose now and request an IV dextrose infusion
Show the answer and rationale

Answer: D

The NPH given at 0800 is still being absorbed and has not yet peaked, but the carbohydrate it was matched to has stopped, so hypoglycemia is the immediate danger: the nurse checks the glucose now and repeatedly and requests the IV dextrose that inpatient protocols use while feedings are interrupted. Holding the next NPH dose is the runner-up, and it will likely be needed, but that dose is hours away and does nothing about the insulin already working. A new tube cannot be used until the x-ray confirms its position, so rushing it in does not bring the carbohydrate back sooner, and juice by mouth risks aspiration in a client who is NPO for dysphagia.

๐Ÿ“š Learn it: NG Tubes, Enteral Feeds and Keeping Food Out of Lungs

Question 5 of 20

A client with chronic constipation is prescribed psyllium powder once daily. Which instruction should the nurse include in the teaching?

  1. Take each dose with your other medicines so none are missed
  2. Expect a bowel movement an hour or two after the first dose
  3. Stir each dose into a full glass of water and let it thicken
  4. Mix each dose in a full glass of water and drink it right away
Show the answer and rationale

Answer: D

Psyllium is a bulk-forming laxative that absorbs water, so each dose is taken with at least 8 ounces (a full glass) of fluid; with too little liquid it can swell and block the throat or esophagus. Using a full glass but letting it thicken is the closest choice, yet the gel becomes hard to swallow and raises the same choking risk, so it is drunk promptly. Psyllium can bind other drugs, so it is taken at least 2 hours apart from them. Bulk-forming agents usually work in 12 to 72 hours, not within an hour or two, and fluid intake stays generous, because fiber without enough water makes constipation worse.

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Question 6 of 20

A nurse is assessing the site of a client's percutaneous endoscopic gastrostomy (PEG) tube, which was placed 3 months ago. Which finding requires the nurse to take action?

  1. The length marking at the skin is 4 cm, matching the number documented last week
  2. A thin ring of dry, yellow crust at the site washes off with soap and water
  3. The external bolster has pressed a deep groove into the skin
  4. The tube turns freely and slides about 1/4 inch in and out at the site
Show the answer and rationale

Answer: C

An external bolster pressed into a deep groove is too tight and can cause pressure injury, leakage, and buried bumper syndrome as the internal bumper erodes into the stomach wall, so the finding needs action and reporting. A tube that turns freely and slides about 1/4 inch in and out is the runner-up because movement can suggest displacement, but slight play is expected at a healed site. A length marking of 4 cm that matches the documented number confirms the tube has not migrated, and a thin ring of dry, yellow crust that washes off with soap and water is expected residue rather than a spreading infection.

๐Ÿ“š Learn it: NG Tubes, Enteral Feeds and Keeping Food Out of Lungs

Question 7 of 20

A client with chronic obstructive pulmonary disease (COPD) has lost 4 kg (8.8 lb) in 3 months and says, 'I get too short of breath to finish a meal.' Which instruction should the nurse give?

  1. Drink a high-calorie supplement shake along with each meal
  2. Choose mostly high-carbohydrate foods for quick, easy energy
  3. Eat three full meals a day and add a high-calorie snack at bedtime
  4. Rest before meals and eat five or six small, high-calorie meals
Show the answer and rationale

Answer: D

Eating takes energy, and a full stomach pushes up on the flattened diaphragm and worsens dyspnea, so a client with COPD who is losing weight rests before eating and takes small, frequent meals that are high in calories and protein. A high-calorie shake is a good idea, which makes that option tempting, but fluids taken with meals fill the stomach, so supplements and other drinks are taken between meals. Three full meals cause the very fullness that cuts the meal short, even with a snack added, and carbohydrates produce the most carbon dioxide as they are used, so extra calories come mainly from protein and fat.

๐Ÿ“š Learn it: The Diet Orders You Must Not Mix Up

Question 8 of 20

A client's small-bore nasogastric feeding tube will not flush, and the feeding pump alarms for an occlusion. The tubing is not kinked, and placement was confirmed earlier in the shift. Which action should the nurse take first?

  1. Force water through with a 3-mL syringe for more pressure
  2. Gently push and pull warm water with a 60-mL syringe
  3. Flush with 30 mL of cranberry juice or cola and let it dwell for 30 minutes
  4. Reinsert the guidewire stylet partway to push the clog through the tube
Show the answer and rationale

Answer: B

Warm water instilled with a 60-mL syringe in a gentle push-pull motion is the initial step for a clogged feeding tube, with a prescribed enzyme solution used per policy if water fails. Flushing with 30 mL of cranberry juice or cola and letting it dwell for 30 minutes is the runner-up because it is a familiar home remedy, but acidic fluids do not dissolve clogs and can clump formula protein and worsen the blockage. Reinserting the guidewire stylet partway can puncture the tube and injure the esophagus or stomach, and forcing water through with a 3-mL syringe generates enough pressure to rupture the tube.

๐Ÿ“š Learn it: NG Tubes, Enteral Feeds and Keeping Food Out of Lungs

Question 9 of 20

A client has a nasogastric tube to low intermittent suction after a bowel resection. At the end of the 12-hour shift the nurse totals the output: nasogastric canister 450 mL, which includes two prescribed 30-mL normal saline irrigations; urine 820 mL; and closed-suction wound drain 35 mL. Agency policy is to subtract irrigant from the nasogastric drainage. How much output should the nurse record for the shift?

  1. 1,275 mL
  2. 1,245 mL
  3. 1,305 mL
  4. 1,210 mL
Show the answer and rationale

Answer: B

Saline instilled into the tube is not body fluid, so under this policy the true nasogastric drainage is 450 โˆ’ (2 ร— 30) = 390 mL. Adding the urine and the wound drain gives 390 + 820 + 35 = 1,245 mL. The runner-up, 1,275 mL, subtracts only one of the two irrigations, and 1,305 mL counts all 60 mL of saline as drainage. Leaving out the drain gives 1,210 mL, but drain output is measured and recorded like any other fluid loss.

๐Ÿ“š Learn it: The Diet Orders You Must Not Mix Up

Question 10 of 20

A client receiving continuous enteral feedings has had five loose stools in the past 24 hours. Which action should the nurse take first?

  1. Review the medication record for sorbitol and antibiotics
  2. Give the prescribed loperamide after the next loose stool and reassess in 4 hours
  3. Dilute the formula to half strength with sterile water for the next 24 hours
  4. Stop the feeding for 24 hours and restart it once the stools return to normal
Show the answer and rationale

Answer: A

Medications are a leading cause of diarrhea during tube feeding, so reviewing the record for sorbitol-containing liquids and antibiotics is the initial step and may reveal the cause or an infection risk. Giving the prescribed loperamide after the next loose stool is the runner-up because a prescription is available, but it should wait until causes such as Clostridioides difficile are considered, since slowing the gut can trap toxin. Diluting the formula to half strength for 24 hours cuts the nutrition delivered without treating the cause, and stopping the feeding for 24 hours until stools normalize is not automatic while the cause is evaluated.

๐Ÿ“š Learn it: NG Tubes, Enteral Feeds and Keeping Food Out of Lungs

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Question 11 of 20

A client with end-stage kidney disease who recently started hemodialysis is reviewing the renal diet with the nurse. Which statement by the client indicates a need for further teaching?

  1. 'I'll count soup and ice cream as fluid intake.'
  2. 'I'll eat as little protein as I can from now on.'
  3. 'I'll have eggs, fish, or chicken at most meals.'
  4. 'I'll avoid potassium-based salt substitutes.'
Show the answer and rationale

Answer: B

Dialysis removes amino acids with each treatment, so clients on maintenance hemodialysis need more protein than before dialysis, about 1.0 to 1.2 g/kg/day, mostly from high-quality sources such as eggs, poultry, and fish; cutting protein to a minimum leads to malnutrition and poor healing. Eggs, fish, or chicken at most meals sounds wrong to anyone who learned that kidney disease calls for low protein, but that limit applies before dialysis starts. Potassium-based salt substitutes are dangerous when the kidneys cannot clear potassium, and soup and ice cream count toward the fluid limit.

๐Ÿ“š Learn it: The Diet Orders You Must Not Mix Up

Question 12 of 20

While the nurse is advancing a nasogastric tube, the client begins coughing forcefully, cannot speak, and appears dusky. Which action should the nurse take first?

  1. Stop advancing until the coughing eases
  2. Apply oxygen and check the saturation
  3. Withdraw the tube immediately
  4. Aspirate contents to test the pH
Show the answer and rationale

Answer: C

Violent coughing, an inability to speak, and a dusky color during insertion mean the tube has likely entered the larynx or trachea, so it is withdrawn immediately and reinserted only after the client recovers. Stopping until the coughing eases sounds cautious, but it leaves the tube in the airway, where the client cannot cough it clear. Oxygen does not remove the cause of the distress, and aspirating to test the pH delays removal when the signs already show airway placement. When the tube is reinserted, having the client tuck the chin toward the chest as it passes the back of the throat helps direct it into the esophagus.

๐Ÿ“š Learn it: NG Tubes, Enteral Feeds and Keeping Food Out of Lungs

Question 13 of 20

A client with heart failure is learning to follow a 2-gram sodium diet. Which statement by the client indicates a need for further teaching?

  1. 'I'll switch to sea salt, since it is a natural salt.'
  2. 'I'll limit bread and cheese, as they hide sodium.'
  3. 'I'll ask my provider before I use salt substitutes.'
  4. 'I'll drain and rinse canned beans and vegetables.'
Show the answer and rationale

Answer: A

Sea salt contains about the same amount of sodium as table salt by weight, so switching to it does not reduce the client's sodium intake. Checking before using a salt substitute sounds overcautious, but most substitutes use potassium chloride, a hyperkalemia risk with ACE inhibitors or spironolactone. Rinsing canned foods removes some sodium, and bread and cheese are hidden sources, since most dietary sodium comes from processed foods rather than the salt shaker.

๐Ÿ“š Learn it: The Diet Orders You Must Not Mix Up

Question 14 of 20

A nurse is removing a nasogastric tube from a client whose bowel function has returned after abdominal surgery. The client is in high Fowler's position, the tube has been disconnected from suction, and the tape has been removed from the nose. Which instruction should the nurse give the client as the tube is withdrawn?

  1. Take small sips of water as the tube comes out to ease it
  2. Swallow several times while I slowly pull the tube out
  3. Breathe in slowly through your mouth as the tube comes out
  4. Take a deep breath and hold it while I pull the tube out
Show the answer and rationale

Answer: D

Holding the breath closes the epiglottis over the airway, so secretions dripping from the tube as it passes the pharynx cannot be inhaled, and the nurse withdraws the tube gently and steadily in one motion. Swallowing is the runner-up because it is what the client does during insertion to guide the tube into the esophagus, but the airway reopens between swallows, while a held breath keeps it closed for the whole pull. Breathing in as the tip passes the throat can draw secretions into the airway, and sips of water add fluid to the pharynx at the moment the airway is least protected.

๐Ÿ“š Learn it: NG Tubes, Enteral Feeds and Keeping Food Out of Lungs

Question 15 of 20

A client who passed a calcium oxalate kidney stone last month is learning how diet can help prevent another stone. Which statement by the client indicates a need for further teaching?

  1. 'I'll eat smaller portions of meat, chicken, and fish.'
  2. 'I'll limit how much vitamin C I take in supplements.'
  3. 'I'll cut back on salty foods like chips and canned soup.'
  4. 'I'll stop eating dairy foods so I take in less calcium.'
Show the answer and rationale

Answer: D

Calcium in food binds oxalate in the intestine so that less oxalate is absorbed and passed into the urine; cutting out dairy raises urinary oxalate and the risk of another stone, so clients with calcium stones keep a normal calcium intake. Limiting vitamin C supplements can sound unrelated, but the body converts large doses of vitamin C into oxalate. Limiting sodium lowers the amount of calcium the kidneys excrete, and smaller servings of meat, chicken, and fish help because animal protein raises urinary calcium.

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Question 16 of 20

A client who aspirated thin liquids on a swallow study after a stroke has a prescription for pureed foods and moderately thick liquids. Which item on the client's lunch tray should the nurse remove?

  1. Cubes of flavored gelatin
  2. Apple juice prethickened to moderately thick
  3. Smooth vanilla pudding
  4. Molded slice of pureed turkey
Show the answer and rationale

Answer: A

Gelatin melts into thin liquid in the mouth, so it counts as a thin liquid and is removed for a client who aspirates thin liquids unless the speech-language pathologist approves it. Gelatin is easy to mistake for a safe soft food because it holds its shape on the tray. The molded turkey slice is the runner-up because it also holds its shape, but it is pureed meat set in a mold and does not melt. The juice is prethickened to the moderately thick consistency prescribed, and smooth pudding stays cohesive and fits a pureed diet.

๐Ÿ“š Learn it: NG Tubes, Enteral Feeds and Keeping Food Out of Lungs

Question 17 of 20

A client with newly diagnosed celiac disease is reviewing the gluten-free diet with the nurse. Which statement by the client indicates a need for further teaching?

  1. 'I may be able to eat oats if they are certified gluten-free.'
  2. 'Rice, corn, and quinoa are safe grains for me.'
  3. 'I'll keep a separate toaster just for my gluten-free bread.'
  4. 'Regular soy sauce is fine, since it's made from soybeans.'
Show the answer and rationale

Answer: D

Most soy sauce is brewed with wheat, so the client chooses a soy sauce or tamari labeled gluten-free; malt and malt vinegar, which come from barley, are other hidden sources. Oats are the runner-up because many clients learn to avoid them, but oats themselves are not the problem: regular oats are often contaminated with wheat during processing, so only certified gluten-free oats are used, with the provider's approval. A shared toaster leaves crumbs that contaminate gluten-free bread, so a separate one is correct, and rice, corn, and quinoa are naturally gluten-free.

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Question 18 of 20

A client who had abdominal surgery yesterday is prescribed a clear liquid diet. Which item on the meal tray should the nurse replace?

  1. Black tea with honey
  2. Lemon ice pop
  3. Orange sherbet
  4. Chicken broth
Show the answer and rationale

Answer: C

Sherbet contains milk or cream, so it belongs on a full liquid diet with ice cream, pudding, and strained cream soups. A clear liquid diet allows only liquids that are clear at room temperature and leave little residue, such as broth, tea or coffee without milk, juices without pulp, and ice pops without fruit pieces or dairy. Students often confuse a fruit ice pop with sherbet because both are frozen and fruit-flavored; the dairy is what makes the difference.

๐Ÿ“š Learn it: The Diet Orders You Must Not Mix Up

Question 19 of 20

A client has been intubated and receiving mechanical ventilation for 3 days after a stroke. Which nursing action best reduces the client's risk of ventilator-associated pneumonia?

  1. Change the ventilator circuit tubing every 24 hours
  2. Instill 5 mL of sterile saline before each suctioning
  3. Keep the bed flat to protect the skin over the sacrum
  4. Keep the head of the bed elevated 30 to 45 degrees
Show the answer and rationale

Answer: D

Raising the head of the bed 30 to 45 degrees reduces reflux and aspiration of oral and gastric secretions past the endotracheal tube cuff, and it is a core part of every ventilator bundle along with minimizing sedation, daily breathing trials, oral care, and early mobility. The ventilator circuit is changed only when it is soiled or malfunctioning, because routine changes add contamination, saline instillation can wash bacteria into the lower airway, and lying flat increases aspiration.

๐Ÿ“š Learn it: NG Tubes, Enteral Feeds and Keeping Food Out of Lungs

Question 20 of 20

A client receiving chemotherapy says the smell of food on the unit makes the nausea worse at mealtimes. Which suggestion should the nurse make?

  1. Lie flat for an hour after eating to let the food settle
  2. Eat your favorite foods on the days you receive treatment
  3. Have hot soup and tea with meals to settle your stomach
  4. Choose cold or room-temperature foods, which have less odor
Show the answer and rationale

Answer: D

Food odors are a strong trigger for nausea, and cold or room-temperature foods give off much less smell than hot ones, so they are often better tolerated, along with small, frequent, bland meals and having someone else do the cooking. Eating favorite foods around treatment can create a lasting aversion to them once they become linked with nausea. Hot soups and drinks carry more odor, and lying flat after eating encourages reflux, so the client rests sitting up.

๐Ÿ“š Learn it: The Diet Orders You Must Not Mix Up

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