Deck 40: Nursing Management: Nutritional Problems

Question 1

When using a soft, silicone nasogastric tube for enteral feedings, the nurse will need to

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 to 5 days to avoid mucosal damage.

Answer 1

flush the tubing after checking for residual volumes.

Question 2

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

A) Teach the patient 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).

Answer 2

Serve multiple small feedings of high-calorie, high-protein foods.

Question 3

Which of these nursing actions included in the plan of care for a patient who is receiving intermittent tube feedings through a percutaneous endoscopic gastrostomy (PEG) tube may be delegated to an LPN/LVN?

A) Providing skin care to the area around the tube site
B) Assessing the patient's nutritional status at least weekly
C) Determining the need for the addition of water to the feedings
D) Teaching the patient and family how to administer tube feedings

Answer 3

Providing skin care to the area around the tube site

Question 4

When assessing a patient who is a vegan, which finding may indicate the need for cobalamin supplementation?

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

Question 5

A 22-year-old who is hospitalized with anorexia nervosa is 5 ft 5 in (163 cm) tall and weighs 90 pounds (41 kg). Laboratory tests reveal hypokalemia and iron-deficiency anemia. Which nursing diagnosis has the highest priority for the patient?

A) Risk for activity intolerance related to anemia and weakness
B) Risk for electrolyte imbalance related to poor eating patterns
C) Ineffective health maintenance related to obsession with body image
D) Imbalanced nutrition: less than body requirements related to refusal to eat

Question 6

Which choice from the hospital menu indicates that the patient has understood the nurse's teaching about choosing high calorie, high protein foods?

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

Question 7

A patient 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 action by the nurse is best?

A) Shut the feeding off 30 to 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 patient to CT scan with oral suction in case of aspiration.

Question 8

A patient who has a wound infection after major surgery has only been taking in about 50% to 75% of the ordered meals and states, "Nothing on the menu really appeals to me." Which action by the nurse will be most effective in improving the patient's oral intake?

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

Question 9

A patient with protein calorie malnutrition who has had abdominal surgery is receiving parenteral nutrition (PN). Which assessment information obtained by the nurse is the best indicator that the patient is receiving adequate nutrition?

A) Blood glucose is 110 mg/dL.
B) Serum albumin level is 3.5 mg/dL.
C) Fluid intake and output are balanced.
D) Surgical incision is healing normally.

Question 10

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

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

Question 11

A 66-year-old patient has a body mass index (BMI) of 31 kg/m², a normal C-reactive protein level, and low transferrin and albumin levels. The nurse will plan patient teaching to increase the patient's intake of foods that are high in

A) iron.
B) protein.
C) calories.
D) carbohydrate.

Question 12

The nurse receives change-of-shift report about the following four patients. Which patient will the nurse assess first?

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

Question 13

The nurse is performing an admission assessment on a 20-year-old college student who is being admitted for electrolyte disorders of unknown etiology. Which assessment finding is most important to report to the health care provider?

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

Question 14

The nurse 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 intervention is the priority?

A) Monitor the patient'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/hr until the new bag arrives

Question 15

When preparing to teach an 82-year-old Hispanic patient who lives with an adult daughter about ways to improve nutrition, which action should the nurse take first?

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

Question 16

How many grams of protein will the nurse recommend to meet the minimum daily requirement for a patient who weighs 145 pounds (66 kg)?

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

Question 17

After 6 hours of parenteral nutrition (PN) infusion, the nurse checks a patient's capillary blood glucose level and finds it to be 120 mg/dL. The most appropriate action by the nurse is to

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 18

Parenteral nutrition (PN) containing amino acids and dextrose was ordered and hung 24 hours ago for a malnourished patient. The nurse observes that about 50 mL remain in the PN container. Which action is best for 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 19

A patient who has just been started on continuous tube feedings of a full-strength commercial formula at 100 mL/hr using a closed system method has six diarrhea stools the first day. Which action 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 20

A patient is receiving tube feedings through a percutaneous endoscopic gastrostomy (PEG). Which action will the nurse include in the plan of care?

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

Question 21

All of the following nursing actions are included in the plan of care for a patient who is malnourished. Which action is appropriate for the nurse to delegate to nursing assistive personnel (NAP)?

A) Assist the patient to choose high nutrition items from the menu.
B) Monitor the patient for skin breakdown over the bony prominences.
C) Offer the patient the prescribed nutritional supplement between meals.
D) Assess the patient's strength while ambulating the patient in the room.

Question 22

While caring for a comatose patient who is receiving continuous enteral nutrition through a soft nasogastric tube, the nurse notes the presence of new crackles in the patient's lungs. In which order will the nurse take the following actions? Put a comma and space between each solve choice (a, b, c, d, etc.) ____________________

A) Turn off the tube feeding.
B) Obtain the patient's oxygen saturation.
C) Check the tube feeding residual volume.
D) Notify the patient's health care provider.

Question 23

During a busy day, the nurse admits all of the following patients to the medical-surgical unit. Which patients 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 débridement 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 ( Deltasone ) daily