Question 1

An older client recovering from aspiration is not scheduled for a swallowing evaluation for several days. Which action should the nurse to help this client?&#10;A) Provide a can of liquid nutritional supplement.&#10;B) Allow the family to bring in favorite foods to support nutritional needs&#10;C) Provide clear liquids and try to reschedule the swallowing test for the next available time slot.&#10;D) Inform the healthcare provider that the test has not been done and discuss concerns about malnutrition

Accepted Answer

The nurse should first inform the healthcare provider that the test was not performed as scheduled and discuss concerns about the potential for malnutrition. Clear liquids should not be used as the only source of nutrition for someone who aspirated. Providing the client with a liquid nutritional supplement could cause further aspiration. Until the swallowing evaluation is completed, oral intake should be closely monitored. The family should withhold bringing in foods until the evaluation is completed.

Question 2

A client is prescribed a mechanical soft diet. When preparing the diet at home, what should the nurse emphasize to the family?&#10;A) Avoid meats which could cause choking or aspiration&#10;B) Add extra salt and fat to improve the taste of the foods&#10;C) Add extra fiber to prevent the material from becoming too soft&#10;D) Include all food groups in the diet to assure that it is nutritionally adequate

Accepted Answer

Including all food groups in appropriate proportions will assure a balanced nutritional intake. Meats that are not tough or include casings or other sources of protein are an essential component in a balanced diet. Extra salt or fat should be avoided since neither is beneficial in excess. Low-fiber diets may be easier to prepare in the consistency required for a mechanical soft diet.

Question 3

The family of a client with a history of a stroke reports only providing the client with nutritional supplements instead of other food to prevent choking. Which response should the nurse make to the family?

A) "It's better to give the client desired foods instead of forcing to eat a diet of solid food."
B) "We will get an evaluation by a nutritionist and speech pathologist to identify the best diet."
C) "Nutritional supplements are high is salt and sugar content and are not a healthy choice for people who can still eat."
D) "Nutritional supplements contain all of the components of a regular diet in liquid form, and are a good option for people who are at risk for aspiration or choking."

"We will get an evaluation by a nutritionist and speech pathologist to identify the best diet."

Accepted Answer

A client who has had a stroke may be at risk for choking or aspiration, and should be evaluated by a nutritionist and speech pathologist who can recommend an appropriate diet. Nutritional supplements are designed to be a source of additional nutrients but aren't adequate as the sole source of food. Nutritional supplements contain balanced amounts of proteins, fats, and carbohydrates.

Question 4

A resident in a skilled nursing facility eats nutritional pudding supplements throughout the day and refuses and is too full to eat regular meals. Which action should the nurse take?&#10;A) Ask the kitchen to provide the client with small portions of meals since they are discarded anyway&#10;B) Ignore the problem since the client probably gets more nutrients eating the supplements than eating the meals&#10;C) Inform the client that too many servings of pudding are not good and meals are a better nutritional option&#10;D) Post a chart that staff must sign when they give the client pudding, and limit the servings to twice a day at least two hours before or after meals

Accepted Answer

Posting a chart to help staff monitor how often and how much pudding the client is given each day along with specifying the amount allowed. Since nutritional supplements are not designed to meet daily nutritional requirements, eating them in place of food is not recommended. Informing the client that eating only supplements does not provide a balanced diet is an important part of client education, but may not result in a behavior change. Asking for a nutritional evaluation may be beneficial to identify client preferences in foods, but smaller portions of the same foods will not make a difference.

Question 5

The nurse manager plans to improve the nutritional status of clients while receiving hospitalized care. What should each nurse be reminded to do when caring for assigned clients?&#10;A) Offer nutritional supplements when requested&#10;B) Provide all clients with a regular diet unless changed by the healthcare provider&#10;C) Instruct dietary staff just to leave food trays in the vestibule for clients who need help with feeding&#10;D) Carefully evaluate the diet order for each client based on individual needs and discuss the cause of inadequate or over adequate intake with the client, caregiver, healthcare provider and nutritionist

Accepted Answer

Careful evaluation of diets is important to assure clients receive food that they will eat. Nutritional supplements should only be provided when there is a medical order for them, since many clients have special nutritional needs. Dietary staff should not be instructed to leave food trays outside the room because this habit often results in delays. Specific diets are ordered by the medical provider based on the metabolic and physical needs of the client.

Question 6

A client is prescribed peripheral parenteral nutrition. For signs of which complication should the nurse monitor this client?&#10;A) Edema&#10;B) Nausea&#10;C) Diarrhea&#10;D) Thrombophlebitis

Accepted Answer

Clients who are expected to receive parenteral nutrition for longer than 10 days should do so through a central vein since thrombophlebitis may result from the infusion of a hypertonic solution in a small vein. If infused properly, diarrhea, nausea, and edema are not common side effects of parenteral nutrition since the solution is carefully formulated to contain a balanced amount of nutrients and vitamins.

Question 7

A client with a vision problem needs assistance with meals. Which statement should the nurse make to help this client during meals? (Select all that apply.)&#10;A) &#34;Let's hurry this up a little.&#34;&#10;B) &#34;Are you anxious about something?&#34;&#10;C) &#34;Feel free to use your fingers to pick up your chicken.&#34;&#10;D) &#34;Your carrots are at the 11 o'clock position on your tray.&#34;&#10;E) &#34;I'm going to mix your spaghetti and green beans together.&#34;

Accepted Answer

It is best to let the client with poor vision know where the foods are located on the meal tray and plate. It is not appropriate to mix foods together. It is best to talk about pleasant things with the client and family, not things that may upset the client. Upsetting conversation topics can reduce hunger. It is fine to encourage the client to eat with their fingers. It is not appropriate to encourage the client to shorten their meal time. The nurse should provide ample time for the client to eat.
It is best to let the client with poor vision know where the foods are located on the meal tray and plate. It is not appropriate to mix foods together. It is best to talk about pleasant things with the client and family, not things that may upset the client. Upsetting conversation topics can reduce hunger. It is fine to encourage the client to eat with their fingers. It is not appropriate to encourage the client to shorten their meal time. The nurse should provide ample time for the client to eat.

Question 8

A client with a critical illness is prescribed parenteral nutrition. Which action should the nurse take when caring for this client?&#10;A) Decrease the amount of infusion slowly based on the oral intake of the client&#10;B) Stop the infusion in the morning and resume oral feeding beginning with clear liquids&#10;C) Follow the facility protocol for tapering the solution, especially monitoring blood glucose levels&#10;D) Follow the facility protocol for tapering the infusion and monitor the input and output for the client each shift

Accepted Answer

Each facility has a protocol or policy for tapering parenteral nutrition that must be followed closely. Parenteral nutrition must be tapered slowly since sudden cessation of high dextrose solutions can lead to hypoglycemia which can be life-threatening. Careful monitoring of blood glucose levels is important. Parenteral nutrition should never be abruptly stopped.

Question 9

The nurse is caring for a client receiving chemotherapy and radiation to treat neck cancer. What should the nurse keep in mind when this client's nutritional support is being determined?&#10;A) Parenteral nutrition would be the easiest to manage in an outpatient setting&#10;B) Enteral nutrition would be more difficult to administer on an outpatient basis&#10;C) Clients receiving parenteral nutrition require daily monitoring by a home care nurse&#10;D) Enteral nutrition would be the best choice because the client has a functional digestive tract

Accepted Answer

Parenteral nutrition requires close monitoring and administration must follow a strict protocol. Because of the components of parenteral nutrition, regular blood glucose measurements to avoid hypo- or hyperglycemia episodes are needed. Enteral nutrition has been shown to have economic and health benefits over parenteral nutrition among clients with functional digestive tracts. Most clients can manage self-feeding with enteral nutritional supplements following education and demonstration by a nurse.

Question 10

A client with chronic pancreatitis is prescribed enteral nutritional supplements with a polymeric formula. For which reason should the nurse question this prescription?&#10;A) Isotonic formulas can cause diarrhea and should be avoided&#10;B) Modular formulas would better address nutritional requirements&#10;C) Clients with chronic pancreatitis require formulas with predigested macronutrients&#10;D) Polymeric formulas contain nutrients which are partially digested and easy to absorb

Accepted Answer

Clients with chronic pancreatitis may have malabsorption problems and benefit from formulas that contain predigested nutrients. Isotonic formulas are less likely to cause diarrhea than hypertonic formulas. Modular formulas are not designed to fully meet daily nutritional requirements. Polymeric formulas contain macronutrients that are intact and require the presence of digestive enzymes to be fully digested.

Question 11

The daughter of a client with terminal brain cancer wants a feeding tube placed so that the client will have nutrition to be cured of the disease. Which response should the nurse make to this daughter?

A) "What does your father want?"
B) "If your father is hungry he will find a way to eat without a stomach tube."
C) "Intravenous fluid contains enough nutrients to meet his nutritional needs."
D) "Palliative nutrition is focused on relieving discomfort and symptoms rather than cure."

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Accepted Answer

The answer of The daughter of a client with terminal...

Question 12

The nurse is providing palliative nutrition to a client with a terminal illness. Which intervention should the nurse include on the client's plan of care?&#10;A) Scheduled rest periods&#10;B) Mouth care and lip lubrication&#10;C) A regular balanced diet with snacks&#10;D) Range-of-motion exercises every 4 hours

Accepted Answer

The answer of The nurse is providing palliative nutrition to...

Question 13

The nurse notes that a client receiving enteral feedings has a residual volume of 315 mL. Which action should the nurse take?&#10;A) Hold tube feeding formula&#10;B) Change tube feeding setup&#10;C) Add blue food dye to formula&#10;D) Increase the head-of-bed to a 45-degree angle

Accepted Answer

The answer of The nurse notes that a client receiving...

Deck 17: Nutrition Care and Support