Question 1

The nurse is caring for an obese client who will be taking orlistat (Xenical)to help her lose weight.Which statement indicates that the client understands teaching about orlistat?&#10;A) &#34;This medication will help speed up my metabolism.&#34;&#10;B) &#34;I may have loose stools after meals if I eat too much fat.&#34;&#10;C) &#34;This medication will suppress my appetite so I won't be hungry.&#34;&#10;D) &#34;This medication will make me feel full after I eat small amounts.&#34;

Accepted Answer

Orlistat (Xenical)inhibits lipase,leading to partial hydrolysis of triglycerides.Fats are only partially digested and absorbed and are excreted in the feces.The client may experience nausea,cramps,and loose stools when fats are increased in the diet.Orlistat does not increase metabolism,suppress appetite,or make the client feel full after small meals.

Question 2

The nurse is caring for a client who is a vegan and has developed B₁₂ deficiency.Which foods does the nurse encourage the client to include in the diet? A) Fortified cereals and tofu B) Pumpkin seeds and blackstrap molasses C) Kale, spinach, and whole grain bread D) Strawberries and sweet red peppers

Accepted Answer

Megaloblastic anemia is caused by lack of folic acid and vitamin B₁₂ in the diet.Vegans are susceptible to this and need to include fortified cereals,soy beverages,or meat substitutes in their diets.The other foods listed are not good sources of folic acid and vitamin B₁₂.

Question 3

The nurse is caring for a female client who is 5 feet,7 inches tall and weighs 115 pounds.The client asks the nurse if she needs to lose weight.Which response by the nurse is best?&#10;A) &#34;Yes. Your body mass index suggests you are slightly overweight.&#34;&#10;B) &#34;Maybe. Let's look at your risks for cardiovascular disease.&#34;&#10;C) &#34;Your weight is just fine. Don't worry about it.&#34;&#10;D) &#34;No. In fact, your body mass index suggests that you are already underweight.&#34;

Accepted Answer

The client's body mass index (BMI)is 18.0,so she is already underweight.It is inaccurate to tell the client she is overweight,and it is unnecessary to consider her weight in light of any cardiovascular risk factors.The nurse should not reassure the client that her weight is just fine because she is underweight.

Question 4

Which dietary adjustments does the nurse recommend to an older adult client asking what changes she should institute to prevent or manage constipation?&#10;A) &#34;Increase your calcium intake.&#34;&#10;B) &#34;Limit your fluid intake.&#34;&#10;C) &#34;Include plenty of fiber.&#34;&#10;D) &#34;Take a laxative with every meal.&#34;

Accepted Answer

Older adults are prone to constipation.To manage or prevent constipation,teach the older client to drink eight glasses of water daily and to take in plenty of fiber.These guidelines are good for other clients as well.The other suggestions will not prevent or help manage constipation.

Question 5

The nurse is caring for a client on a limited income who has been diagnosed with kwashiorkor.Which foods does the nurse suggest to improve the client's nutritional status with minimal increase in food costs?

A) Oatmeal and bananas
B) Tomato soup with oyster crackers
C) Omelet made with cheddar cheese
D) Whole wheat pasta with tomato sauce

Accepted Answer

Kwashiorkor develops as a result of lack of protein intake despite adequate calories.The client needs to increase protein-containing foods.Eggs and cheese are high-protein foods that are less expensive than meats.Pasta,vegetables,fruit,and oatmeal have less protein than eggs and cheese.

Question 6

The nurse is caring for an overweight client who gained 10 pounds during the previous 2 weeks.The client states that she is hungry all the time and doesn't understand why.Which assessment finding could explain the client's weight gain and hunger?

A) The client started taking dexamethasone (Decadron) daily.
B) The client started taking naproxen sodium (Naprosyn) daily.
C) The client's glycosylated hemoglobin level is 6%.
D) The client's thyroxine (T₄) level is 8 mcg/dL.

Accepted Answer

Dexamethasone is a corticosteroid.These drugs alter carbohydrate,protein,and lipid metabolism,predisposing the client to obesity when taken on a long-term basis.In addition,corticosteroids increase the client's appetite.Naprosyn is an NSAID,which can lead to gastric upset and ulceration and decreased appetite and weight loss.The client's glycosylated hemoglobin and thyroid levels are within normal limits and would not explain the hunger and weight gain.

Question 7

Which client is at highest risk for developing dehydration and hypernatremia as a result of enteral feedings? A) Client receiving an isotonic enteral feeding solution and an IV of D₅W (dextrose 5% in water) at 83 mL/hr B) Client receiving a hypertonic enteral feeding solution and an IV of normal saline (0.9 NS) at 125 mL/hr C) Client who can drink liquids and is receiving a supplemental hypertonic enteral feeding solution D) Client receiving a hypertonic enteral feeding solution and an IV of 0.45% NS (0.45 NS) infusing at 125 mL/hr

Accepted Answer

Hypertonic enteral tube feedings can easily lead to dehydration and hypernatremia if not balanced with hypotonic IV solution.D₅W and 0.45 NS are hypotonic solutions.A client with hypertonic feedings who can drink liquids should have enough oral fluid intake to prevent dehydration and hypernatremia.The client receiving both a hypertonic enteral feeding and an isotonic IV solution would be at highest risk.

Question 8

The nurse is caring for a client who was started on total parenteral nutrition (TPN)2 days previously.The client reports blurred vision,dry mouth,and frequent urination.Which is the nurse's priority action?

A) Weigh the client.
B) Assess the client's vital signs.
C) Slow down the TPN infusion.
D) Assess the client's blood sugar.

Accepted Answer

Dry mouth,frequent urination,and blurred vision all are symptoms of hyperglycemia,a potential complication of TPN infusion.The nurse should assess the client's blood sugar level.Weighing the client and checking vital signs will not help with assessment of hyperglycemia.The nurse should obtain an order from the provider to slow the TPN solution.

Question 9

A facility is beginning to perform bariatric surgery on obese clients.Which action by the nursing manager is most important?&#10;A) Obtain appropriately sized equipment for these clients.&#10;B) Select a dedicated group of staff members for these clients.&#10;C) Send personnel to sensitivity training as part of orientation.&#10;D) Establish multidisciplinary rounding for clients in this program.

Accepted Answer

All actions might be appropriate and helpful in the care of bariatric clients.However,staff and client safety is a unique priority when working with this group of clients.The manager must ensure appropriately sized equipment,so that neither staff nor clients injure themselves.

Question 10

A client who is malnourished has a total lymphocyte count of 1450/mm³.Which instruction does the nurse provide to the unlicensed assistive personnel helping to care for this client? A) "Wash your hands or use hand foam when you first enter the room." B) "Be sure to offer this client a glass of water each time you are with the client." C) "You may need to open cartons and packages on the client's food tray." D) "Record all of the client's food and drink intake for the shift."

Accepted Answer

Clients who are malnourished often have a low total lymphocyte count,which puts them at higher risk for infection.The nurse should emphasize good hand hygiene.The other interventions may be appropriate depending on client needs,but good hand hygiene would be the priority.

Question 11

A client has a small-bore nasoenteric feeding tube.The nurse assesses the following vital signs: temperature,100.2° F (37.8° C); pulse,112 beats/min; respiratory rate,22 breaths/min; and blood pressure,106/62 mm Hg.Which action by the nurse takes priority?

A) Remove the tube immediately and notify the heath care provider.
B) Auscultate lung sounds and obtain oxygen saturation.
C) Add blue dye to the feeding tube formula.
D) Auscultate bowel sounds and slow the feeding down.

Accepted Answer

The answer of A client has a small-bore nasoenteric feeding...

Question 12

A severely malnourished client was started on enteral feedings.The following day,the client is confused,has a heart rate of 112 beats/min,and reports feeling weak.Which laboratory value does the nurse correlate with this condition?

A) Serum phosphate, 1.8 mg/dL
B) Serum potassium, 3.1 mEq/L
C) Serum sodium, 143 mEq/L
D) Serum glucose, 110 mg/dL

Accepted Answer

The answer of A severely malnourished client was started on...

Question 13

The nurse is caring for a client who has a new small-bore nasoduodenal tube for feedings.Which intervention most effectively prevents clogging of the tube?&#10;A) Administering medications that have been thoroughly crushed and dissolved in cold water&#10;B) Flushing the feeding tube with 60 mL of cranberry juice or carbonated beverage four times daily&#10;C) Irrigating the tube with water before and after administration of medications using 20 to 30 mL&#10;D) Diluting the tube feeding to half-strength with cold water before infusion into the feeding tube

Accepted Answer

The answer of The nurse is caring for a client...

Question 14

Which statement indicates that the client needs additional discharge teaching after gastric bypass surgery?&#10;A) &#34;I hope my type 2 diabetes is cured and I won't need insulin anymore.&#34;&#10;B) &#34;As soon as I get home, I'm going to enjoy a nice bowl of fruit.&#34;&#10;C) &#34;If I get nauseated, I know I'm eating too much at one time.&#34;&#10;D) &#34;I will be sure to report any back, shoulder, or abdominal pain.&#34;

Accepted Answer

The answer of Which statement indicates that the client needs...

Question 15

The postanesthesia care nurse is caring for a client who had gastric banding surgery and was extubated an hour ago.The client's blood gases are as follows: pH,7.22; HCO₃^- 21 mEq/L; PCO₂,65 mm Hg; and PO₂,58 mm Hg.Which is the priority action by the nurse?

A) Assess the client's airway.
B) Increase the client's oxygen flow rate.
C) Check the client's oxygen saturation level.
D) Document findings in the client's chart.

Accepted Answer

The answer of The postanesthesia care nurse is caring for...

Question 16

The nurse is preparing to administer tube feedings through a client's new Salem sump nasogastric tube.The nurse is unable to withdraw any fluid from the tube before starting the feeding.Which is the priority action of the nurse?

A) Start the tube feeding as ordered and check the residual in 30 minutes.
B) Inject air into the nasogastric tube while auscultating the client's epigastric area.
C) Lower the head of the client's bed and attempt to aspirate fluid again.
D) Obtain orders for a chest x-ray to confirm placement before starting the feeding.

Accepted Answer

The answer of The nurse is preparing to administer tube...

Question 17

The nurse is caring for an anorexic client who is severely malnourished.A nasogastric feeding tube is inserted,and tube feedings are started.Which laboratory finding is the best indication that the client's nutritional status is improving?

A) Sodium has risen from 130 to 144 mg/dL.
B) Creatinine has dropped from 1.9 to 0.5 mg/dL.
C) Prealbumin level has risen from 9 to 13 mg/dL.
D) Blood urea nitrogen (BUN) level has dropped from 15 to 11 mg/dL.

Accepted Answer

The answer of The nurse is caring for an anorexic...

Question 18

The nurse is reviewing recent laboratory values for a client who is being treated for malnutrition.Which laboratory finding indicates that the client is not receiving adequate iron supplementation?&#10;A) Hematocrit, 31%&#10;B) Serum albumin, 3.5 g/dL&#10;C) Creatine phosphokinase (CPK), 55 U/mL&#10;D) Erythrocyte sedimentation rate (ESR), 15.8 mm/hr

Accepted Answer

The answer of The nurse is reviewing recent laboratory values...

Question 19

The nurse is caring for a male client who is 6 feet,1 inch tall and weighs 215 pounds.The client asks the nurse if his weight is appropriate for his height.Which is the nurse's best response?&#10;A) &#34;Your weight is just about right for someone your height.&#34;&#10;B) &#34;Your weight is a few pounds under the ideal for your height.&#34;&#10;C) &#34;Your weight is a few pounds over the ideal for your height.&#34;&#10;D) &#34;Your weight is quite a few pounds over the ideal for your height.&#34;

Accepted Answer

The answer of The nurse is caring for a male...

Question 20

The new nursing supervisor at a long-term care facility is concerned about the number of residents who appear malnourished.Which action by the nurse is best?&#10;A) Institute daily weighing for at-risk or underweight residents.&#10;B) Provide a supply of easy to access high-calorie snacks.&#10;C) Ask dining room personnel about residents coughing at meals.&#10;D) Assess the residents' opinions on the quality of food served.

Accepted Answer

The answer of The new nursing supervisor at a long-term...

Question 21

A client is malnourished and needs encouragement and assistance to eat.Which activities does the nurse delegate to the unlicensed assistive personnel (UAP)when giving this client a food tray?&#10;A) Open food packages and cut food if needed.&#10;B) Remove the urinal from the bedside table.&#10;C) Assess the client's ability to swallow.&#10;D) Report to the nurse pain described by the client.&#10;E) Sit with the client and do not rush the feeding.

Accepted Answer

The answer of A client is malnourished and needs encouragement...

Question 22

When reviewing an older client's medical record,which findings lead the nurse to perform a nutrition assessment?&#10;A) Widow/widower status&#10;B) Chronic constipation&#10;C) History of depression&#10;D) Random blood sugar level of 198 mg/dL&#10;E) Cholecystectomy 4 years ago&#10;F) Inability to afford a new pair of glasses

Accepted Answer

The answer of When reviewing an older client's medical record,which...

Question 23

The nurse is teaching a health promotion class about weight loss and asks students to list health risks that can occur as a result of obesity.Which student responses indicate that additional teaching is required?

A) Sleep apnea
B) Infertility
C) Rheumatoid arthritis
D) Cervical cancer
E) Cholecystitis
F) Hypothyroidism

Accepted Answer

The answer of The nurse is teaching a health promotion...

Deck 63: Care of Patients With Malnutrition and Obesity