Nutrition & Hydration Practice Test

Answer: D — Canned soups are among the highest sodium foods available - a single serving can contain 800 to 1200 mg of sodium, which may be most or all of a restricted resident daily allowance. The canning and preservation process relies heavily on salt. Fresh vegetables, plain grilled meats, and fresh fruits are naturally very low in sodium and are appropriate choices. The CNA should be familiar with common high-sodium foods (canned goods, processed meats, pickles, chips, soy sauce, cheese) to help residents make proper choices within their prescribed diet.

Answer: D — A diabetic diet does not eliminate all sugars or carbohydrates - rather, it carefully controls the amount, type, and timing of carbohydrate intake to maintain stable blood glucose levels throughout the day. Carbohydrates have the greatest direct impact on blood sugar. The diet typically includes consistent carbohydrate portions at each meal, emphasis on complex carbohydrates and fiber over simple sugars, balanced nutrition across all food groups, and regular meal timing. The CNA should ensure the resident receives the correct tray and eats meals on schedule.

Answer: D — A renal diet is designed for residents with kidney disease and typically restricts several nutrients that damaged kidneys cannot properly filter or balance: potassium (found in bananas, oranges, potatoes, tomatoes), phosphorus (found in dairy, nuts, beans, dark sodas), sodium (salt), and sometimes protein and total fluid intake. The specific restrictions depend on the stage of kidney disease and whether the resident is on dialysis. This is one of the most complex therapeutic diets, and the CNA must ensure the correct diet tray is served.

Answer: A — A low-fat diet restricts the total amount of fat (especially saturated and trans fats) and cholesterol in the diet. It is commonly prescribed for residents with coronary artery disease, high cholesterol (hyperlipidemia), gallbladder disease, pancreatitis, or obesity. Foods to limit include fried foods, fatty meats, full-fat dairy products, butter, lard, and processed baked goods. The CNA should ensure the resident receives the correct low-fat diet tray and report if the resident receives or requests high-fat foods that are not part of their prescribed plan.

Answer: D — A pureed diet requires that ALL foods are blended, processed, or mashed to a completely smooth, uniform, pudding-like consistency with absolutely no lumps, chunks, or solid pieces. Even a single small lump can cause a choking or aspiration event in a resident with dysphagia. Each food item is typically pureed separately and presented attractively on the plate (not mixed together). The CNA should inspect the tray before serving to ensure there are no solid pieces and should report any improperly prepared foods to the dietary department immediately.

Answer: A — Thin liquids (water, juice, coffee, broth) are the most dangerous consistency for residents with dysphagia because they flow quickly and unpredictably through the throat, making them very difficult to control during swallowing. Thickened liquids move more slowly, giving the impaired swallowing muscles additional time to coordinate and direct the liquid safely into the esophagus rather than the airway (trachea). Liquids are thickened to specific consistencies as ordered by the speech therapist: nectar-thick, honey-thick, or pudding-thick. The CNA must NEVER give thin liquids to a resident ordered thickened liquids.

Answer: C — The CNA must NEVER give thin liquids to a resident who has been prescribed thickened liquids - this dietary order exists because a swallowing evaluation determined that thin liquids pose a serious aspiration risk for this resident. Giving regular water could cause the liquid to enter the airway and lungs, potentially leading to aspiration pneumonia - a life-threatening condition. The CNA should empathize with the resident thirst, explain the safety reason kindly, and offer an appealing thickened alternative. Ice chips are also thin liquid when melted and are equally dangerous. If the resident continues to refuse thickened liquids, report to the nurse.

Answer: C — A clear liquid diet includes only fluids and foods that are transparent and liquid at room temperature: water, clear juices without pulp (apple, grape, cranberry), broth (chicken, beef, vegetable), plain gelatin, popsicles, clear sodas, tea, and coffee without cream. Milk is NOT a clear liquid because it is opaque. Clear liquid diets are typically ordered before surgery, after certain procedures, during acute illness, or as a transition diet. They provide hydration and minimal calories but are not nutritionally complete for long-term use.

Answer: D — Residents must be positioned as upright as possible (60 to 90 degrees, ideally sitting in a chair or with the head of bed elevated to high Fowler position) during all meals and snacks. This upright positioning uses gravity to help food and liquids travel safely down the esophagus into the stomach. Lying flat or in a reclined position dramatically increases the risk of aspiration - where food or liquid enters the airway and lungs. The resident should remain upright for at least 30 minutes after eating to allow food to move through the upper digestive tract.

Answer: B — The CNA should sit at the resident eye level (never stand over them), offer small bites (about one-third of a spoon), name each food being offered so the resident knows what they are eating, allow plenty of time for thorough chewing and complete swallowing before offering the next bite, alternate between foods and beverages as the resident prefers, and never rush the meal. Mixing foods together removes the resident ability to taste individual items and is disrespectful. Rushing increases choking and aspiration risk significantly.

Answer: B — Food must always be placed on the unaffected (stronger) side of the mouth because a stroke often paralyzes or severely weakens the facial muscles, tongue, and swallowing mechanism on the affected side. Placing food on the paralyzed right side means the resident cannot properly chew, manipulate, or move the food toward the throat for safe swallowing, which dramatically increases choking and aspiration risk. The CNA should also check the affected cheek after the meal for pocketed food that the resident may not feel.

Answer: A — The clock method describes food placement as if the plate were a clock face - for example: Your mashed potatoes are at 12 o clock, green beans are at 3 o clock, and chicken is at 6 o clock. Your drink is at the upper right of your tray. This technique empowers the visually impaired resident to locate and eat food independently, preserving their dignity and autonomy. The CNA should also describe each food item, offer to open containers or cut food, and consistently place utensils and beverages in the same location at every meal.

Answer: A — Built-up (padded or ergonomic) handles on forks, spoons, and knives have a larger, thicker, often textured grip that requires significantly less finger strength and dexterity to hold securely. They are essential adaptive devices for residents with arthritis, weak hand grip, stroke-related hand weakness, Parkinson disease tremors, or any condition that limits fine motor control. Using adaptive utensils promotes self-feeding independence, preserves dignity, maintains hand function, and reduces the resident frustration during meals.

Answer: B — Coughing, choking, throat clearing, a wet or gurgling voice quality during or after swallowing, watery eyes, facial redness, and food or liquid coming out of the nose are all warning signs of aspiration - where food or liquid enters the airway instead of the esophagus. If any of these signs occur, the CNA must immediately stop the meal, position the resident upright, allow them to cough to clear the airway, and report the episode to the nurse. Continued feeding during aspiration signs forces more material into the lungs and can cause life-threatening aspiration pneumonia.

Answer: A — Residents with dysphagia (and all residents generally) should remain in an upright position (sitting in a chair or with head of bed elevated to at least 30 to 45 degrees) for a minimum of 30 minutes after completing a meal or snack. This allows gravity to continue assisting food and liquids through the esophagus and into the stomach, and prevents gastroesophageal reflux (stomach contents flowing back up) which can lead to aspiration even after the meal is over. Lowering the resident to a flat position too soon after eating significantly increases aspiration risk.

Answer: B — The chin tuck (chin down) technique is a compensatory swallowing strategy prescribed by the speech therapist in which the resident tucks their chin slightly downward toward their chest during the swallow. This position narrows the airway entrance and widens the esophageal opening, helping to direct food and liquids into the esophagus rather than the trachea. It is commonly used for residents with dysphagia to reduce aspiration risk. The CNA should gently remind the resident to tuck their chin before each swallow as instructed in the care plan.

Answer: C — Forceful coughing indicates the resident body is attempting to clear a partial airway obstruction - this is an effective defense mechanism and should be encouraged, not interrupted. The CNA should stop the meal immediately, remain calm, encourage the resident to keep coughing, stay with them, and prepare to perform abdominal thrusts (Heimlich maneuver) if the resident stops being able to cough, speak, or breathe (signs of complete obstruction). Giving water during a choking episode can worsen the blockage. The incident must be reported to the nurse regardless of the outcome.

Answer: A — For accurate intake and output measurement, the CNA must count ALL sources of fluid intake: water, juices, coffee, tea, milk, soda, soup broth, and any food item that becomes liquid at room temperature - including gelatin (Jell-O), ice cream, sherbet, popsicles, and ice chips (counted at approximately half their volume since ice melts to about half the volume of fluid). Between-meal fluids and snacks must also be counted. Accurate I and O tracking helps the healthcare team monitor hydration status, kidney function, heart function, and the effectiveness of diuretic medications.

Answer: B — One standard cup or 8 fluid ounces equals approximately 240 milliliters (mL). This is a critical conversion that every CNA must memorize because fluid intake and output are typically recorded in milliliters on the I and O sheet. Other common conversions include: 1 ounce equals 30 mL, a 4-ounce juice cup equals 120 mL, a standard coffee mug (6 ounces) equals 180 mL, and a standard water pitcher may hold 1000 mL (1 liter). Accurate measurement requires knowing the volume of each container used in the facility.

Answer: C — Vomiting (emesis) must be measured, described, and recorded as OUTPUT on the I and O sheet because it represents fluid leaving the body. The CNA should note the approximate amount (in mL), color (clear, yellow, green/bile, brown, red/bloody), consistency (watery, mucus, food particles), and any unusual odor, then report it to the nurse promptly. Vomiting is significant because it causes fluid loss that can lead to dehydration, electrolyte imbalance, and aspiration risk. Bloody or coffee-ground colored emesis is an emergency that requires immediate reporting.

Answer: A — Consistently poor food intake (less than 25 percent of meals) over multiple days is a significant clinical finding that puts the resident at risk for malnutrition, unintentional weight loss, muscle wasting, weakened immune function, poor wound healing, pressure ulcer development, and overall health decline. The CNA must document the percentage of each meal consumed and report consistently poor intake to the nurse so the care team can investigate the cause (pain, depression, medication side effects, dental problems, nausea, food preferences) and intervene before serious complications develop.

Answer: C — Key signs of dehydration include: dark concentrated (amber or tea-colored) urine, decreased urine output, dry mouth and mucous membranes, poor skin turgor (skin that tents or remains elevated when gently pinched and released), sunken eyes, confusion or increased confusion, dizziness, rapid pulse, low blood pressure, and constipation. Elderly residents are at particularly high risk because their thirst sensation diminishes with age. The CNA should encourage regular fluid intake throughout the day, offer fluids at every interaction, and report signs of dehydration to the nurse immediately.

Answer: B — Most residents need approximately 1500 to 2000 mL of fluid daily (unless restricted by the care plan). The CNA should offer fluids frequently throughout the day - not just at meals - by keeping preferred beverages within reach, offering drinks during every interaction (medication times, repositioning, between meals), providing a variety of fluid choices (water, juice, milk, coffee, tea), and making fluids easily accessible with adaptive cups or straws when needed. Relying solely on the resident to ask is inadequate because elderly residents often have a diminished thirst sensation and will not request fluids even when dehydrated.

Answer: C — Unintentional weight loss in an elderly resident is NEVER considered normal and is always a significant finding that must be reported to the nurse. It can indicate depression, infection, cancer, thyroid disorders, medication side effects, dental problems, dysphagia, cognitive decline (forgetting to eat), chronic disease progression, or social isolation. Even a 5 percent weight loss over one month or 10 percent over six months is clinically significant. The CNA should document the weight, report it promptly, and continue to monitor and record food intake percentages at every meal.

Answer: D — When a resident is on a fluid restriction, the CNA must carefully track and manage intake throughout the entire day to ensure the total stays within the prescribed limit. With 1000 mL consumed and only 200 mL remaining, the CNA should work with the nurse to allocate the remaining amount wisely across evening needs (dinner beverage, medication administration, bedtime). Ice chips DO count as fluid intake (at approximately half their frozen volume). The CNA should never allow unlimited intake that exceeds the restriction or completely cut off all fluids, as both are medically harmful.