KMU Past Paper Practice

Question: A 74-year-old patient admitted after abdominal surgery has bilateral pitting oedema and a stable recorded body weight. His family reports that his clothes have become loose and he has eaten very little for three weeks. Which interpretation best guides nutritional assessment?

Stable weight rules out important malnutrition

Oedema may conceal loss of body tissue

Oedema confirms satisfactory protein intake

Current weight determines total nutritional needs

Normal body weight excludes muscle depletion

Correct Answer: Oedema may conceal loss of body tissue

Explanation: Fluid accumulation can mask loss of muscle and fat; nutritional assessment must consider intake and tissue loss, not weight alone.

Question: A 63-year-old patient is recovering from surgery and reports eating only a few mouthfuls at each meal. The nutrition team needs an objective method to decide whether additional support is required. Which approach is most useful?

Estimate needs from appetite alone

Measure only the most recent weight

Use serum sodium as a calorie marker

Record intake against estimated requirements

Measure daily urine volume as food intake

Correct Answer: Record intake against estimated requirements

Explanation: Comparing actual intake with estimated energy and protein needs identifies whether the patient is receiving sufficient nutrition.

Question: A patient with marked swallowing difficulty is alert and wants to continue eating. A bedside swallow assessment raises concern that liquids enter the airway. Which consideration should determine the immediate feeding plan?

Assessment of swallowing safety before oral feeding

Selection of a higher-calorie oral drink

Increasing the volume of each oral meal

Offering liquids while the patient lies flat

Changing the oral diet to a sweeter formula

Correct Answer: Assessment of swallowing safety before oral feeding

Explanation: Unsafe swallowing increases aspiration risk; the feeding route should be selected only after swallowing safety has been considered.

Question: A 51-year-old patient with a non-functioning bowel is started on parenteral nutrition. The surgical team is planning reassessment over the coming days. Which development would most strongly support a move toward gastrointestinal nutritional delivery?

New requirement for blood glucose checks

Need for a different venous dressing

Persistent inability to tolerate any feed

Continued absence of bowel absorption

Return of safe and adequate gut function

Correct Answer: Return of safe and adequate gut function

Explanation: When the gastrointestinal tract becomes usable, oral or enteral nutrition can be introduced and parenteral support reduced as appropriate.

Question: A 68-year-old man requires nasogastric nutritional support. He has sustained facial trauma involving the nose and midface after a road traffic collision. Which initial action best addresses the procedure-related concern?

Select the nostril with less swelling

Obtain senior assessment of a safer alternative

Increase lubrication before blind insertion

Use a thinner tube without further assessment

Insert the tube while the patient is supine

Correct Answer: Obtain senior assessment of a safer alternative

Explanation: Significant nasal or midfacial trauma can make blind nasal tube passage hazardous; an alternative route requires assessment.

Question: A patient with a correctly placed nasogastric feeding tube complains of increasing nasal soreness after a week of feeding. The skin at the nostril is red where the tube presses against it. Which preventive measure best addresses this problem?

Increase the concentration of the feed

Reduce all prescribed water flushes

Secure the tube without pressure and inspect skin

Replace enteral nutrition with intravenous glucose

Keep the tube tightly taped against the nostril

Correct Answer: Secure the tube without pressure and inspect skin

Explanation: Tube fixation and regular inspection reduce pressure-related skin and nasal injury while preserving tube position.

Question: A 59-year-old man receiving gastric tube feeding develops loose stools. His feed is otherwise being delivered as prescribed, and he has recently started an antibiotic. Which assessment is most appropriate before blaming the enteral formula?

Check for medication-related diarrhoea and other causes

Assume the feeding route is permanently unsuitable

Diagnose bowel obstruction from stool frequency

Stop every form of nutritional support indefinitely

Conclude that gastric tube placement is incorrect

Correct Answer: Check for medication-related diarrhoea and other causes

Explanation: Diarrhoea during enteral feeding has several causes, including medication effects; assessment should precede changing or stopping nutrition.

Question: A woman is being prepared for PEG insertion after discussion of prolonged swallowing impairment. She asks how food will reach her stomach after the procedure. Which explanation best describes the access created?

A tube will deliver feed into a central vein

A tube will terminate in the nasal cavity

A tube will bypass both stomach and intestines

A tube will enter the stomach through the abdominal wall

A tube will deliver nutrition into a peripheral vein

Correct Answer: A tube will enter the stomach through the abdominal wall

Explanation: PEG creates a feeding route through the abdominal wall into the stomach, allowing enteral nutrition when swallowing is inadequate.

Question: A PEG-dependent patient develops a small amount of persistent leakage around the tube with surrounding moist, irritated skin. There is no fever or severe abdominal pain. What is the most appropriate next step?

Tighten external fixation forcefully against the skin

Assess tube position, fixation and local skin care

Double the feeding rate to reduce leakage time

Ignore leakage because it confirms tube patency

Remove the tube without examining the site

Correct Answer: Assess tube position, fixation and local skin care

Explanation: Leakage can irritate the stoma and may reflect tube or fixation problems; assess the site and device before intervening.

Question: A patient requires parenteral nutrition expected to last only a short period, and the prescribed formulation is suitable for a peripheral vein. Which principle supports using peripheral rather than central access?

Peripheral delivery removes all infusion complications

Peripheral delivery permits every hyperosmolar formula

Peripheral delivery eliminates electrolyte monitoring

Peripheral delivery provides direct intestinal feeding

A suitable lower-osmolarity solution may avoid central access

Correct Answer: A suitable lower-osmolarity solution may avoid central access

Explanation: Peripheral parenteral nutrition is an option for suitable less concentrated solutions over a limited period, but still requires monitoring.

Question: A 66-year-old patient has central venous access for nutritional infusion. During ward review, the nurse notes that the dressing has become loose and the insertion site is exposed. What is the best preventive response?

Leave the site exposed to improve air circulation

Change the nutritional solution to oral glucose

Restore an appropriate aseptic catheter dressing

Flush the line more frequently without site care

Remove laboratory monitoring from the care plan

Correct Answer: Restore an appropriate aseptic catheter dressing

Explanation: Maintaining a clean, intact aseptic dressing reduces the opportunity for organisms to enter at the catheter site.

Question: A patient receiving parenteral nutrition has serum glucose values that vary widely during the day. The prescription has remained unchanged despite a new postoperative infection. Which factor best explains why monitoring requirements may change?

Clinical illness can alter metabolic tolerance to nutrients

Stable nutrition composition guarantees stable glucose

Glucose control depends only on intravenous access site

Parenteral nutrition does not influence blood glucose

Infection prevents any measurement of serum glucose

Correct Answer: Clinical illness can alter metabolic tolerance to nutrients

Explanation: Stress and infection can change insulin sensitivity and glucose use, making repeated assessment necessary even with an unchanged prescription.

Question: A man receiving parenteral nutrition has persistent nausea and a new rise in triglyceride concentration after the lipid component of his prescription was increased. Which nutritional review is most relevant?

Increase lipid administration despite the result

Discontinue recording fluid input and output

Replace central access with a nasal feeding tube

Assess lipid delivery and metabolic tolerance

Interpret triglyceride elevation as improved nutrition

Correct Answer: Assess lipid delivery and metabolic tolerance

Explanation: Raised triglycerides during parenteral nutrition warrant review of the lipid prescription and the patient’s ability to handle infused fat.

Question: A postoperative patient on intravenous nutrition has a high recorded urine output and large fluid losses from an intestinal stoma. His blood pressure is falling and his mucous membranes are dry. Which interpretation best integrates the observations?

Stoma losses should be excluded from the chart

Unreplaced measured losses may cause volume depletion

Urine output alone proves adequate hydration

Parenteral nutrition prevents dehydration by definition

Dry mucosa indicates excessive protein delivery

Correct Answer: Unreplaced measured losses may cause volume depletion

Explanation: Stoma and urinary losses contribute to fluid depletion; intake–output records must be interpreted with haemodynamic findings.

Question: A patient has received nutritional support for ten days. The team sees a modest increase in body weight but also new ankle swelling. Which additional observation best helps judge whether nutrition is improving?

The brand of tubing used for nutrition

The day on which the catheter was inserted

The colour of the nutrition infusion bag

The number of ward visits by relatives

Serial dietary intake, functional status and clinical examination

Correct Answer: Serial dietary intake, functional status and clinical examination

Explanation: Changes in intake, physical findings and functional recovery are more informative than weight alone when oedema is present.

Question: A malnourished patient is identified as being at risk of complications when feeding is restarted. The team wants to identify electrolyte depletion before the first major increase in nutrition. Which group of laboratory measurements is most relevant?

Bilirubin, albumin and cholesterol only

Haemoglobin, platelets and white-cell count only

Phosphate, potassium and magnesium

Troponin, creatine kinase and lactate only

Amylase, lipase and calcium only

Correct Answer: Phosphate, potassium and magnesium

Explanation: Phosphate, potassium and magnesium are essential baseline measurements in patients at risk of refeeding-related electrolyte shifts.

Question: Before nasogastric feeding begins, a patient asks what may happen if the tube accidentally enters the respiratory tract. Which consequence best explains why position must be checked?

Feed may enter the airway and injure the lungs

Gastric acid production will permanently stop

Intravenous catheter thrombosis will develop

Absorption of enteral nutrients will become excessive

The abdominal feeding stoma will become infected

Correct Answer: Feed may enter the airway and injure the lungs

Explanation: Incorrect airway placement can deliver feed into the respiratory tract; reliable position confirmation is therefore a major safety requirement.

Question: A capable patient has been advised to undergo PEG insertion. After hearing the indication and risks, she declines the procedure and asks whether alternatives are available. Which response best reflects appropriate counselling?

Arrange insertion without discussing the refusal

Seek family consent in place of her decision

State that nutritional risk automatically removes choice

Discuss feasible alternatives and respect an informed decision

Withhold all information until the procedure is booked

Correct Answer: Discuss feasible alternatives and respect an informed decision

Explanation: Valid consent requires explanation of alternatives and respect for a patient’s informed decision when they have capacity.

Question: A patient receiving enteral feeding is discharged home with a caregiver. The caregiver is worried about recognizing a problem with the tube. Which information is the most useful safety message?

Observe only the total number of daily feeds

Continue feeds through a tube that has clearly moved

Report new pain, leakage, blockage or breathing difficulty

Avoid checking the skin around the insertion site

Ignore vomiting if the prescribed calories are delivered

Correct Answer: Report new pain, leakage, blockage or breathing difficulty

Explanation: Teaching caregivers to recognize tube displacement, blockage, local complications and aspiration symptoms supports early review.

Question: A hospitalized patient requires prolonged nutrition through a central venous catheter. His care team is considering both nutrition delivery and ongoing review. Which plan best balances treatment with safety?

Monitor catheter condition but omit nutritional assessment

Measure body weight alone and ignore laboratory trends

Use a fixed prescription regardless of changing illness

Discontinue fluid records after the first infusion day

Review clinical progress, line safety and laboratory trends together

Correct Answer: Review clinical progress, line safety and laboratory trends together

Explanation: Safe parenteral support combines nutritional assessment with catheter surveillance, fluid balance and biochemical monitoring.