Deck 6: Nutritional Support

Question 1

In evaluating a patient's nutrition,the nurse would monitor which blood test as the most sensitive indicator of protein synthesis and catabolism?

A) Albumin
B) BUN
C) Prealbumin
D) Triglycerides

Answer 1

Prealbumin

Question 2

Objective data designating that the nutrition goals are not being met include

A) hyperglycemia, normovolemia, and increased protein level.
B) overhydration, hypoglycemia, and weight gain.
C) weight gain, inconsistent glucose, and normovolemia.
D) weight loss, elevated glucose, and dehydration.

Answer 2

weight loss, elevated glucose, and dehydration.

Question 3

A patient with acute pancreatitis is started on parenteral nutrition.The student nurse listed possible interventions for this patient.Which intervention needs correction before finalizing the plan of care?

A) Change the intravenous tubing every 24 hours.
B) Infuse antibiotics through the intravenous line.
C) Monitor the blood glucose every 6 hours.
D) Monitor the fluid and electrolyte balance.

Answer 3

Infuse antibiotics through the intravenous line.

Question 4

A patient with a history of emphysema,diabetes,and hyperlipidemia is in the critical care unit on a ventilator.The nutrition assessment notes that the patient has a protein and vitamin deficiency and is underweight.Which formula for nutritional assessment is most appropriate?

A) Elemental protein formula
B) Fiber-added formula
C) High medium-chain triglyceride formula
D) Lactose-free formula

Question 5

In addition to residual stomach volume,what other evidence suggests feeding intolerance?

A) Abdominal distension
B) Absence of tympany on percussion
C) Active bowel sounds
D) Elevated blood glucose by fingerstick

Question 6

A patient has been admitted to the critical care unit after a stroke.After "failing" a swallow study,the patient is placed on enteral feedings.Following placement of a nasogastric tube for tube feeding,what is the next critical step?

A) Administer medications.
B) Cap off and wait 24 hours before starting feedings.
C) Obtain a chest radiograph.
D) Start the tube feeding.

Question 7

The best nursing approach to prevent feeding tube obstruction is to

A) dilute the feeding to make it flow more easily.
B) flush the tube every 4 hours with 20 to 30 mL of tap water.
C) pass a stylet daily to keep the tubing clear.
D) use a larger bore tube where possible.

Question 8

The patient is to start parenteral nutrition.The nurse knows to prepare which site for catheter insertion?

A) Basilic vein
B) Femoral vein
C) Radial artery
D) Subclavian vein

Question 9

A patient is being fed through a nasogastric tube placed in his stomach.The nurse would carry out which intervention to minimize aspiration risk?

A) Add blue dye to the formula.
B) Assess the residual every hour.
C) Elevate the head of the bed 30 degrees.
D) Provide feedings via continuous infusion.

Question 10

A patient is being ventilated and has been started on enteral feedings with a nasogastric small-bore feeding tube.What is the primary reason the nurse must frequently assess tube placement?

A) To assess for paralytic ileus
B) To maintain the patency of the feeding tube
C) To monitor for skin breakdown on the nose
D) To prevent aspiration of the feedings

Question 11

A patient is having complications from abdominal surgery and remains NPO.Because enteral tube feedings are not possible,the decision is to initiate parenteral feedings.What are the major complications for this therapy?

A) Aspiration pneumonia and sepsis
B) Sepsis and fluid and electrolyte imbalances
C) Fluid overload and pulmonary edema
D) Hypoglycemia and renal insufficiency

Question 12

An important nutritional consideration in the elderly population is

A) a decrease in protein requirements.
B) an increase in caloric requirements with age.
C) the potential for drug-nutrient interaction related to polypharmacy.
D) the presence of other diseases that decrease caloric needs.

Question 13

A critically ill patient has a nonhealing wound and malnutrition.Which component of nutritional supplementation is most important for this patient to receive?

A) Arginine
B) Omega-3 fatty acids
C) Branched-chain amino acids
D) Vitamin A

Question 14

A patient who is receiving continuous enteral feedings has just vomited 250 mL of milky green fluid.What action by the nurse takes priority?

A) Notify the provider.
B) Assess the patient's lungs and oxygen saturation.
C) Stop the tube feeding.
D) Slow the rate of the infusion.

Question 15

A patient is receiving enteral tube feedings and has developed drug-nutrient interactions.The nurse recognizes which drug as having the potential for causing drug-nutrient reactions?

A) Aspirin
B) Enoxaparin
C) Ibuprofen
D) Phenytoin

Question 16

Select the physiological reasoning behind enteral therapy as the preferred source of nutritional therapy.

A) Gut overgrowth increases.
B) Gastroparesis increases.
C) Bacterial translocation is initiated.
D) Gut mucosa is preserved.

Question 17

Approximately 5 days after starting tube feedings,a patient develops extreme diarrhea.A stool specimen is collected to check for which possible cause?

A) Clostridium difficile
B) Escherichia coli
C) Occult blood
D) Ova and parasites

Question 18

The nurse identifies which patient at greatest risk for malabsorption of protein?

A) The patient with gallbladder obstruction
B) The patient with ileitis
C) The patient with distal colon resection
D) The patient with jejunal tumor

Question 19

Which statement is true about normal function of the gastrointestinal (GI)tract?

A) Failure of the tight junctions allows bacteria to invade the GI tract.
B) The gut lacks protective mechanisms; thus, infection is always a concern.
C) Water is reabsorbed at the beginning of the colon.
D) Without nutritional stimulation, mucosal villi atrophy.

Question 20

A patient is receiving enteral feedings and reports fullness and abdominal discomfort.What action by the nurse is best?

A) Connect the feeding tube to suction.
B) Continue the tube feeding.
C) Decrease the tube feeding.
D) Assess the patient's gastric residual.

Question 21

Calorie-dense feedings: (Select all that apply.)

A) are most useful in heart failure and liver disease.
B) are most useful in malabsorption syndromes.
C) contain 2 kcal/mL and 70 g protein/L.
D) include increased fiber.
E) are especially good for patients with lung disease.

Question 22

Patients experiencing severe physiological stress increase their nutritional requirements to:

A) 20 kcal/kg/day.
B) 30 kcal/kg/day.
C) 35 kcal/kg/day.
D) 50 kcal/kg/day.

Question 23

Which of the following statements is true about insulin and parenteral nutrition? (Select all that apply.)

A) The amount of parenteral insulin is adjusted based on the previous 24-hour laboratory values.
B) Insulin may be added to a parenteral nutrition solution.
C) Subcutaneous insulin is used on a sliding scale during parenteral nutrition.
D) Supplemental insulin is rarely required for patients receiving parenteral nutrition.
E) Lingering hyperglycemia after parenteral nutrition has stopped requires continuing insulin.

Question 24

Risks of total parenteral nutrition include: (Select all that apply.)

A) diarrhea.
B) elevated blood sugar.
C) infection at the catheter site.
D) volume overload.
E) aspiration.

Question 25

Malnutrition contributes to infection risk by

A) hampering normal gastrointestinal motility.
B) impairing immune function.
C) increasing blood glucose.
D) increasing drug interactions.

Question 26

The correct order of actions for a patient starting enteral nutrition with a feeding tube is: _______________,_______________,_______________,_______________,_______________.

A)initiate tube feeding
B)insert feeding tube
C)flush tube to verify patency
D)obtain chest radiograph
E)assess residuals

Question 27

A patient,who has a tube feeding,requires a chest x-ray study for evaluation of a cough.To reduce the risk of aspiration,the nurse:

A) helps the radiology technician to position the patient to avoid dislodging the tube.
B) slows the rate of the feedings until placement has been verified.
C) cuts the infusion rate by half.
D) stops feedings 10 to 15 minutes before placing flat to obtain the radiograph.

Question 28

Which interventions are critical during intravenous lipid administration? (Select all that apply.)

A) Assess glucose levels every 6 hours.
B) Change the tubing every 24 hours.
C) Hold lipids when administering antibiotics through the same line.
D) Monitor triglyceride levels periodically.
E) Maintain elevation of the head of the bed.

Question 29

Which statements about total parenteral nutrition are correct? (Select all that apply.)

A) assessing fluid volume status and preventing infection are important nursing considerations.
B) fingerstick glucose levels are assessed every 6 hours and prn.
C) total parenteral nutrition is administered through a feeding tube and pump.
D) total parenteral nutrition with added lipids provides adequate levels of protein, carbohydrates, and fats.
E) soy-based lipids should not be given during the first week of a critical illness.

Question 30

A patient with severe burns had a dietitian consultation for nutritional support.The patient weighs 145 pounds.What recommendations by the dietitian does the nurse anticipate initiating? (Select all that apply.)

A) At least 2307 kcal/day
B) Juven formula
C) 2 cal HN formula
D) At least 1648 kcal/day
E) Perative formula