Deck 42: Nursing Management Nutritional Problems

Question 1

The nurse is admitting a client with a body mass index (BMI) of 17 kg/m2 and a low albumin level. Which of the following assessment findings should the nurse expect to find?

A)Restlessness
B)Hypertension
C)Pitting edema
D)Food allergies

Answer 1

Pitting edema

Question 2

The student nurse is caring for a client who is receiving intermittent tube feedings. Which of the following actions by the student nurse should cause the RN to intervene in the clients' care?

A)Positions the head of the bed 30 degrees
B)Flushes the tube before and after the feeding
C)Checks residual volume every hour
D)Maintains the elevated bed position one hour after the feeding.

Answer 2

Checks residual volume every hour

Question 3

The nurse receives change-of-shift report about the following four clients. Which of the following clients should the nurse assess first?

A)A client who has malnutrition associated with 4+ generalized pitting edema
B)A client whose parenteral nutrition has 10 mL of solution left in the infusion bag
C)A client whose gastrostomy tube is plugged after crushed medications were given through the tube
D)A client who is receiving continuous enteral feedings and has new-onset crackles throughout the lungs

Answer 3

A client who is receiving continuous enteral feedings and has new-onset crackles throughout the lungs

Question 4

Which of the following actions should the nurse implement when using a soft, silicone nasogastric tube for enteral feedings?

A)Avoid giving medications through the feeding tube.
B)Flush the tubing after checking for residual volumes.
C)Administer continuous feedings using an infusion pump.
D)Replace the tube every 3-5 days to avoid mucosal damage.

Question 5

The nurse is teaching a client about a high calorie, high protein diet. Which of the following menu choices indicates that the teaching has been effective?

A)Baked fish with applesauce
B)Beef noodle soup and canned corn
C)Fresh vegetables with yogourt topping
D)Fried chicken with potatoes and gravy

Question 6

The nurse is caring for a client with anorexia nervosa who is 163 cm tall and weighs 41 kg. Laboratory tests reveal hypokalemia and iron-deficiency anemia. Which of the following nursing diagnoses has the highest priority for the client?

A)Risk for activity intolerance as evidenced by physical deconditioning
B)Risk for electrolyte imbalance as evidenced by insufficient fluid volume
C)Ineffective health maintenance related to ineffective coping strategies (obsession with body image)
D)Imbalanced nutrition: less than body requirements related to insufficient dietary intake

Question 7

How many grams of protein will the nurse recommend to meet the minimum daily requirement for a client who weighs 66 kg?

A)36
B)53
C)75
D)98

Question 8

The nurse is caring for a client who has a wound infection after major surgery and has only been taking in about 50% to 75% of the ordered meals. The client states, "Nothing on the menu really appeals to me." Which of the following actions by the nursewill be most effective in improving the client's oral intake?

A)Make a referral to the dietitian.
B)Order at least six small meals daily.
C)Teach the client about high-calorie, high-protein foods.
D)Have family members bring in favourite foods from home.

Question 9

The nurse is caring for a client who is receiving tube feedings through a percutaneous endoscopic gastrostomy (PEG). Which of the following actions should the nurse include in the plan of care?

A)Keep the client positioned on the left side.
B)Obtain a daily x-ray to verify tube placement.
C)Check the gastric residual volume every 4-6 hours.
D)Avoid giving bolus tube feedings through the PEG tube.

Question 10

The nurse has just started a client on continuous tube feedings of a full-strength commercial formula at 100 mL/hour using a closed system method and has had six diarrhea stools the first day. Which of the following actions should the nurse plan to take?

A)Slow the infusion rate of the tube feeding.
B)Check gastric residual volumes more frequently.
C)Change the enteral feeding system and formula every 8 hours.
D)Discontinue administration of water through the feeding tube.

Question 11

Which of the following actions should the nurse take first in order to improve calorie and protein intake for a client who eats only about 50% of each meal because of "feeling too tired to eat much"?

A)Teach the client about the importance of good nutrition.
B)Serve multiple small feedings of high-calorie, high-protein foods.
C)Obtain an order for enteral feedings of liquid nutritional supplements.
D)Consult with the health care provider about providing parenteral nutrition (PN).

Question 12

The nurse is admitting a client for electrolyte disorders of unknown etiology. Which of the following findings is most important to report to the health care provider?

A)The client's knuckles are macerated.
B)The client uses laxatives on a daily basis.
C)The client has a history of weight fluctuations.
D)The client's serum potassium level is 2.9 mmol/L.

Question 13

The nurse is caring for a client and notes that the peripheral parenteral nutrition (PN) bag has only 20 mL left and a new PN bag has not yet arrived from the pharmacy. Which of the following interventions is priority?

A)Monitor the client's capillary blood glucose until a new PN bag is hung.
B)Flush the peripheral line with saline and wait until the new PN bag is available.
C)Infuse 5% dextrose in water until the new PN bag is delivered from the pharmacy.
D)Decrease the rate of the current PN infusion to 10 mL/hour until the new bag arrives.

Question 14

The nurse is preparing to teach an 82-year-old Indigenous client who lives with an adult daughter about ways to improve nutrition. Which of the following actions should the nurse take first?

A)Ask the daughter about the client's food preferences.
B)Determine who shops for groceries and prepares the meals.
C)Question the client about how many meals per day are eaten.
D)Assure the client that culturally appropriate foods will be included.

Question 15

The nurse is assessing a client who is a vegan. Which of the following findings may indicate the need for cobalamin supplementation?

A)Anemia
B)Ecchymoses
C)Dry, scaly skin
D)Gingival swelling

Question 16

The nurse is caring for a client with protein calorie malnutrition who has had abdominal surgery and is receiving parenteral nutrition (PN). Which of the following findings is the best indicator that the client is receiving adequate nutrition?

A)Blood glucose is 6.1 mmol/L.
B)Serum albumin level is 35 g/L.
C)Fluid intake and output are balanced.
D)Surgical incision is healing normally.

Question 17

The nurse is caring for a client with a body mass index (BMI) of 31 kg/m2, anormal C-reactive protein level, and low transferrin and albumin levels. The nurse will plan client teaching to increase the client's intake of foods that are high in which of the following?

A)Iron
B)Protein
C)Calories
D)Carbohydrate

Question 18

After 6 hours of parenteral nutrition (PN) infusion, the nurse checks a client's capillary blood glucose level and finds it to be 6.7 mmol/L. Which of the following actions should the nurse take?

A)Obtain a venous blood glucose specimen.
B)Slow the infusion rate of the PN infusion.
C)Recheck the capillary blood glucose in 4 hours.
D)Notify the health care provider of the glucose level.

Question 19

The nurse is caring for a client who is malnourished and is receiving parenteral nutrition (PN) containing amino acids and dextrose for the past 24 hours. The nurse observes that about 50 mL remain in the PN container. Which of the following actions is bestfor the nurse to take?

A)Ask the health care provider to clarify the written PN order.
B)Add a new container of PN using the current tubing and filter.
C)Hang a new container of PN and change the IV tubing and filter.
D)Infuse the remaining 50 mL and then hang a new container of PN.

Question 20

The nurse is caring for a client who is receiving continuous enteral nutrition through a small-bore silicone feeding tube, has a computed tomography (CT) scan ordered, and will have to be placed in a flat position for the scan. Which of the following actionsby the nurse is best?

A)Shut the feeding off 30-60 minutes before the scan.
B)Ask the health care provider to reschedule the CT scan.
C)Connect the feeding tube to continuous suction during the scan.
D)Send the client to CT scan with oral suction in case of aspiration.

Question 21

The nurse is caring for a client who is to have a bolus tube feeding. Which of the following actions should the nurse implement?

A)Deliver the feeding via a syringe over 15 minutes.
B)Increase the rate of the tube feeding to deliver the bolus over 5 minutes.
C)Withhold water by mouth for 30 minutes prior to the bolus feeding.
D)Question the order as tube feedings are not to be delivered as a bolus.

Question 22

During a busy day, the nurse admits all of the following clients to the medical-surgical unit. Which clients are most important to refer to the dietitian for a complete nutritional assessment? (Select all that apply.)

A)A 24-year-old who has a history of weight gains and losses
B)A 53-year-old who complains of intermittent nausea for the past 2 days
C)A 66-year-old who is admitted for debridement of an infected surgical wound
D)A 45-year-old admitted with chest pain and possible myocardial infarction (MI)
E)A 32-year-old with rheumatoid arthritis who takes prednisone daily

Question 23

The nurse is caring for a comatose client who is receiving continuous enteral nutrition through a soft nasogastric tube and notes the presence of new crackles in the client's lungs. In which order will the nurse take the following actions?

A)Turn off the tube feeding.
B)Document assessment findings.
C)Check the tube feeding residual volume.
D)Notify the client's health care provider.