Question 1

After abdominal surgery,a patient with protein calorie malnutrition is receiving parenteral nutrition (PN).Which is the best indicator that the patient is receiving adequate nutrition?

Accepted Answer

Because poor wound healing is a possible complication of malnutrition for this patient,normal healing of the incision is an indicator of the effectiveness of the PN in providing adequate nutrition.Blood glucose is monitored to prevent the complications of hyperglycemia and hypoglycemia,but it does not indicate that the patient's nutrition is adequate.The intake and output will be monitored,but do not indicate that the PN is effective.The albumin level is in the low-normal range but does not reflect adequate caloric intake,which is also important for the patient.

Question 2

A patient is receiving continuous enteral nutrition through a small-bore silicone feeding tube.What should the nurse plan for when this patient has a computed tomography (CT)scan ordered?

Accepted Answer

The tube feeding should be shut off 30 to 60 minutes before any procedure requiring the patient to lie flat.Because the CT scan is ordered for diagnosis of patient problems,rescheduling is not usually an option.Prevention,rather than treatment,of aspiration is needed.Small-bore feeding tubes are soft and collapse easily with aspiration or suction,making nasogastric suction of gastric contents unreliable.

Question 3

A patient's capillary blood glucose level is 120 mg/dL 6 hours after the nurse initiated a parenteral nutrition (PN)infusion.The most appropriate action by the nurse is to

Accepted Answer

Mild hyperglycemia is expected during the first few days after PN is started and requires ongoing monitoring.Because the glucose elevation is small and expected,notification of the health care provider is not necessary.There is no need to obtain a venous specimen for comparison.Slowing the rate of the infusion is beyond the nurse's scope of practice and will decrease the patient's nutritional intake.

Question 4

A 60-year-old man who is hospitalized with an abdominal wound infection has only been eating about 50% of meals and states,"Nothing on the menu sounds good." Which action by the nurse will be most effective in improving the patient's oral intake?

Accepted Answer

The patient's statement that the hospital foods are unappealing indicates that favorite home-cooked foods might improve intake.The other interventions may also help improve the patient's intake,but the most effective action will be to offer the patient more appealing foods.

Question 5

A 20-year-old man with extensive facial injuries from a motor vehicle crash is receiving tube feedings through a percutaneous endoscopic gastrostomy (PEG).Which action will the nurse include in the plan of care?

Accepted Answer

The gastric residual volume is assessed every 4 to 6 hours to decrease the risk for aspiration.The patient does not need to be positioned on the left side.Bolus feedings can be administered through a PEG tube.An x-ray is obtained immediately after placement of the PEG tube to check position,but daily x-rays are not needed.

Question 6

A malnourished patient is receiving a parenteral nutrition (PN)infusion containing amino acids and dextrose from a bag that was hung 24 hours ago.The nurse observes that about 50 mL remain in the PN container.Which action is best for the nurse to take?

Accepted Answer

All PN solutions are changed at 24 hours.PN solutions containing dextrose and amino acids require a change in tubing and filter every 72 hours rather than daily.Infusion of the additional 50 mL will increase patient risk for infection.Changing the IV tubing and filter more frequently than required will unnecessarily increase costs.The nurse (not the health care provider)is responsible for knowing the indicated times for tubing and filter changes.

Question 7

Which menu choice indicates that the patient is implementing plans to choose high-calorie,high-protein foods?

Accepted Answer

Foods that are high in calories include fried foods and those covered with sauces.High protein foods include meat and dairy products.The other choices are lower in calories and protein.

Question 8

Which action should the nurse take first when preparing to teach a frail 79-year-old Hispanic man who lives with an adult daughter about ways to improve nutrition?

Accepted Answer

The family member who shops for groceries and cooks will be in control of the patient's diet,so the nurse will need to ensure that this family member is involved in any teaching or discussion about the patient's nutritional needs.The other information will also be assessed and used but will not be useful in meeting the patient's nutritional needs unless nutritionally appropriate foods are purchased and prepared.

Question 9

A 48-year-old man who has just been started on tube feedings of full-strength formula at 100 mL/hr has 6 diarrhea stools the first day.Which action should the nurse plan to take?

Accepted Answer

Loose stools indicate poor absorption of nutrients and indicate a need to slow the feeding rate or decrease the concentration of the feeding.Water should be given when patients receive enteral feedings to prevent dehydration.When a closed enteral feeding system is used,the tubing and formula are changed every 24 hours.High residual volumes do not contribute to diarrhea.

Question 10

A 20-year-old female is being admitted for electrolyte disorders of unknown etiology.Which assessment finding is most important to report to the health care provider?

Accepted Answer

The low serum potassium level may cause life-threatening cardiac dysrhythmias,and potassium supplementation is needed rapidly.The other information will also be reported because it suggests that bulimia may be the etiology of the patient's electrolyte disturbances,but it does not suggest imminent life-threatening complications.

Question 11

A healthy 28-year-old woman patient who weighs 145 pounds (66 kg)asks the nurse about the minimum daily requirement for protein.How many grams of protein will the nurse recommend?

Accepted Answer

The recommended daily protein intake is 0.8 to 1 g/kg of body weight,which for this patient is 66 kg × 0.8 g = 52.8 or 53 g/day.

Question 12

When caring for a 63-year-old woman with a soft,silicone nasogastric tube in place for enteral feedings,the nurse will

Accepted Answer

The soft silicone feeding tubes are small in diameter and can easily become clogged unless they are flushed after the nurse checks the residual volume.Either intermittent or continuous feedings can be given.The tubes are less likely to cause mucosal damage than the stiffer polyvinyl chloride tubes used for nasogastric suction and do not need to be replaced at certain intervals.Medications can be given through these tubes,but flushing after medication administration is important to avoid clogging.

Question 13

A 76-year-old woman with a body mass index (BMI)of 17 kg/m² and a low serum albumin level is being admitted by the nurse.Which assessment finding will the nurse expect to find?

Accepted Answer

Edema occurs when serum albumin levels and plasma oncotic pressure decrease.The blood pressure and level of consciousness are not directly affected by malnutrition.Food allergies are not an indicator of nutritional status.

Question 14

A patient hospitalized with chronic heart failure eats only about 50% of each meal and reports "feeling too tired to eat." Which action should the nurse take first?

Accepted Answer

Eating small amounts of food frequently throughout the day is less fatiguing and will improve the patient's ability to take in more nutrients.Teaching the patient may be appropriate,but will not address the patient's inability to eat more because of fatigue.Tube feedings or PN may be needed if the patient is unable to take in enough nutrients orally,but increasing the oral intake should be attempted first.

Question 15

A 19-year-old female admitted with anorexia nervosa is 5 ft 6 in (163 cm)tall and weighs 88 pounds (41 kg).Laboratory tests reveal hypokalemia and iron-deficiency anemia.Which nursing diagnosis has the highest priority?

Accepted Answer

The patient's hypokalemia may lead to life-threatening cardiac dysrhythmias.The other diagnoses are also appropriate for this patient but are not associated with immediate risk for fatal complications.

Question 16

Which action for a patient receiving tube feedings through a percutaneous endoscopic gastrostomy (PEG)may be delegated to a licensed practical/vocational nurse (LPN/LVN)?

Accepted Answer

LPN/LVN education and scope of practice include actions such as dressing changes and wound care.Patient teaching and complex assessments (such as patient nutrition and hydration status)require registered nurse (RN)-level education and scope of practice.

Question 17

A patient's peripheral parenteral nutrition (PN)bag is nearly empty and a new PN bag has not arrived yet from the pharmacy.Which intervention is the priority?

Accepted Answer

To prevent hypoglycemia,the nurse should infuse a 5% dextrose solution until the next PN bag can be started.Decreasing the rate of the ordered PN infusion is beyond the nurse's scope of practice.Flushing the line and then waiting for the next bag may lead to hypoglycemia.Monitoring the capillary blood glucose is appropriate but is not the priority.

Question 18

A 48-year-old woman has a body mass index (BMI)of 31 kg/m²,a normal C-reactive protein level,and low serum transferrin and albumin levels.The nurse will plan patient teaching to increase the patient's intake of foods that are high in

Accepted Answer

The patient's C-reactive protein and transferrin levels indicate low protein stores.The BMI is in the obese range,so increasing caloric intake is not indicated.The data do not indicate a need for increased carbohydrate or iron intake.

Question 19

After change-of-shift report,which patient will the nurse assess first?

Accepted Answer

The patient data suggest aspiration has occurred and rapid assessment and intervention are needed.The other patients should also be assessed as quickly as possible,but the data about them do not suggest any immediately life-threatening complications.

Question 20

Which finding for a 19-year-old female who is a vegan may indicate the need for cobalamin supplementation?

Accepted Answer

Cobalamin (vitamin B??)cannot be obtained from foods of plant origin,so the patient will be most at risk for signs of cobalamin deficiency,such as paresthesias,peripheral neuropathy,and anemia.The other symptoms listed are associated with other nutritional deficiencies but would not be associated with a vegan diet.

Quiz 40: Nursing Management: Nutritional Problems

After abdominal surgery,a patient with protein calorie malnutrition is receiving parenteral nutrition (PN) .Which is the best indicator that the patient is receiving adequate nutrition?

A patient is receiving continuous enteral nutrition through a small-bore silicone feeding tube.What should the nurse plan for when this patient has a computed tomography (CT) scan ordered?

A patient's capillary blood glucose level is 120 mg/dL 6 hours after the nurse initiated a parenteral nutrition (PN) infusion.The most appropriate action by the nurse is to

A 60-year-old man who is hospitalized with an abdominal wound infection has only been eating about 50% of meals and states,"Nothing on the menu sounds good." Which action by the nurse will be most effective in improving the patient's oral intake?

A 20-year-old man with extensive facial injuries from a motor vehicle crash is receiving tube feedings through a percutaneous endoscopic gastrostomy (PEG) .Which action will the nurse include in the plan of care?

A malnourished patient is receiving a parenteral nutrition (PN) infusion containing amino acids and dextrose from a bag that was hung 24 hours ago.The nurse observes that about 50 mL remain in the PN container.Which action is best for the nurse to take?

Which menu choice indicates that the patient is implementing plans to choose high-calorie,high-protein foods?

Which action should the nurse take first when preparing to teach a frail 79-year-old Hispanic man who lives with an adult daughter about ways to improve nutrition?

A 48-year-old man who has just been started on tube feedings of full-strength formula at 100 mL/hr has 6 diarrhea stools the first day.Which action should the nurse plan to take?

A 20-year-old female is being admitted for electrolyte disorders of unknown etiology.Which assessment finding is most important to report to the health care provider?

A healthy 28-year-old woman patient who weighs 145 pounds (66 kg) asks the nurse about the minimum daily requirement for protein.How many grams of protein will the nurse recommend?

When caring for a 63-year-old woman with a soft,silicone nasogastric tube in place for enteral feedings,the nurse will

A 76-year-old woman with a body mass index (BMI) of 17 kg/m² and a low serum albumin level is being admitted by the nurse.Which assessment finding will the nurse expect to find?

A patient hospitalized with chronic heart failure eats only about 50% of each meal and reports "feeling too tired to eat." Which action should the nurse take first?

A 19-year-old female admitted with anorexia nervosa is 5 ft 6 in (163 cm) tall and weighs 88 pounds (41 kg) .Laboratory tests reveal hypokalemia and iron-deficiency anemia.Which nursing diagnosis has the highest priority?

Which action for a patient receiving tube feedings through a percutaneous endoscopic gastrostomy (PEG) may be delegated to a licensed practical/vocational nurse (LPN/LVN) ?

A patient's peripheral parenteral nutrition (PN) bag is nearly empty and a new PN bag has not arrived yet from the pharmacy.Which intervention is the priority?

A 48-year-old woman has a body mass index (BMI) of 31 kg/m²,a normal C-reactive protein level,and low serum transferrin and albumin levels.The nurse will plan patient teaching to increase the patient's intake of foods that are high in

After change-of-shift report,which patient will the nurse assess first?

Which finding for a 19-year-old female who is a vegan may indicate the need for cobalamin supplementation?