Deck 6: Nutritional Support

Question 1

Approximately 5 days after starting tube feedings,a patient develops extreme diarrhea.A stool specimen is collected to check for which possible cause?

A) Clostridium difficile
B) Escherichia coli
C) Occult blood
D) Ova and parasites

Answer 1

Clostridium difficile

Question 2

A patient is having complications from abdominal surgery and remains NPO.Because enteral tube feedings are not possible,the decision is to initiate parenteral feedings.What are the major complications for this therapy?

A) Aspiration pneumonia and sepsis
B) Fluid and electrolyte imbalances and sepsis
C) Fluid overload and pulmonary edema
D) Hypoglycemia and renal insufficiency

Answer 2

Fluid and electrolyte imbalances and sepsis

Question 3

Select the physiological reasoning behind enteral therapy as the preferred source of nutritional therapy.

A) Gut overgrowth increases.
B) Gastroparesis increases.
C) Bacterial translocation is initiated.
D) Gut mucosa is preserved.

Answer 3

Gut mucosa is preserved.

Question 4

A patient's feeding tube has been successfully placed in the small intestine with continuous flow tube feeding.The nurse knows that this approach was chosen because:

A) intermittent feedings cause increased nausea and vomiting.
B) the increased filling of the stomach increases absorption.
C) the intestinal mucosa normally receives nutrients from the stomach in peristaltic waves.
D) this will prevent malabsorption syndrome.

Question 5

An important nutritional consideration in the elderly population is:

A) decreased protein requirements.
B) increasing caloric requirements with age.
C) potential for drug-nutrient interaction related to polypharmacy.
D) presence of other diseases that decrease caloric needs.

Question 6

The nurse identifies which patient at greatest risk for malabsorption of protein?

A) The patient with gallbladder obstruction
B) The patient with ileitis
C) The patient with distal colon resection
D) The patient with jejunal tumor

Question 7

A patient is receiving enteral tube feedings and has developed drug-nutrient interactions.The nurse recognizes which drug as having the potential for causing drug-nutrient reactions?

A) Aspirin
B) Enoxaparin
C) Ibuprofen
D) Phenytoin

Question 8

Which statement is true about normal function of the gastrointestinal (GI)tract?

A) Failure of the tight junctions allows bacteria to invade the GI tract.
B) The gut lacks protective mechanisms; thus, infection is always a concern.
C) Water is reabsorbed at the beginning of the colon.
D) Without nutritional stimulation, mucosal villi atrophy.

Question 9

A patient has been admitted to the critical care unit after a stroke.After "failing" a swallow study,the patient is placed on enteral feedings.Following placement of a nasogastric tube for tube feeding,what is the next critical step?

A) Administer medications.
B) Cap off and wait 24 hours before starting feedings.
C) Obtain a chest radiograph.
D) Start the tube feeding.

Question 10

A patient who is receiving continuous enteral feedings has just vomited 250 mL of milky green fluid.This is a concern because this most likely demonstrates that the patient has:

A) a bowel obstruction.
B) developed an ileus.
C) gastrointestinal bleeding.
D) tube feeding intolerance.

Question 11

A patient is being ventilated and has been started on enteral feedings with a nasogastric small-bore feeding tube.What is the primary reason the nurse must frequently assess tube placement?

A) To assess for paralytic ileus
B) To maintain the patency of the feeding tube
C) To monitor for skin breakdown on the nose
D) To prevent aspiration of the feedings

Question 12

Objective data designating that the nutrition goals are not being met include:

A) hyperglycemia, normovolemia, and increased protein level.
B) overhydration, hypoglycemia, and weight gain.
C) weight gain, inconsistent glucose, and normovolemia.
D) weight loss, elevated glucose, and dehydration.

Question 13

A patient with a history of emphysema,diabetes,and hyperlipidemia is in the critical care unit on a ventilator.The nutrition assessment notes that the patient has a protein and vitamin deficiency and is underweight.Which formula for nutritional assessment is most appropriate?

A) Elemental protein formula
B) Fiber-added formula
C) High medium-chain triglyceride formula
D) Lactose-free formula

Question 14

A patient is receiving enteral feedings and has just vomited 250 mL of milky green liquid.The nurse holds the tube feeding,which had been infusing at 100 mL/hr.The nurse knows that the next action should be:

A) connect the feeding tube to suction.
B) continue the tube feeding.
C) decrease the tube feeding.
D) recheck the residual in 2 hours.

Question 15

In addition to residual stomach volume,what other evidence suggests feeding intolerance?

A) Abdominal distention
B) Absence of tympany on percussion
C) Active bowel sounds
D) Elevated blood glucose by fingerstick

Question 16

The patient is to start parenteral nutrition.The nurse knows to prepare which site for catheter insertion?

A) Basilic vein
B) Femoral vein
C) Radial artery
D) Subclavian vein

Question 17

A patient with acute pancreatitis is started on parenteral nutrition.The student nurse listed possible interventions for this patient.Which intervention needs correction before finalizing the plan of care?

A) Change the intravenous tubing every 24 hours.
B) Infuse antibiotics through the intravenous line.
C) Monitor the blood glucose every 6 hours.
D) Monitor the fluid and electrolyte balance.

Question 18

In evaluating a patient's nutrition,the nurse would monitor which blood test as the most sensitive indicator of protein synthesis and catabolism?

A) Albumin
B) BUN
C) Prealbumin
D) Triglycerides

Question 19

In trauma patients,enteral nutrition via nasogastric tube feedings into the small bowel is best initiated within what time frame following the injury?

A) 24 hours
B) 48 hours
C) 7 days
D) 72 hours

Question 20

A patient is being fed through a nasogastric tube placed in his stomach.The nurse would carry out which intervention to minimize aspiration risk?

A) Add blue dye to the formula.
B) Assess the residual every hour.
C) Elevate the head of the bed 30 degrees.
D) Provide feedings via continuous infusion.

Question 21

Patients experiencing severe physiological stress increase their nutritional requirements to:

A) 20 kcal/kg/day.
B) 30 kcal/kg/day.
C) 35 kcal/kg/day.
D) 50 kcal/kg/day.

Question 22

Which of the following statements is true about insulin and parenteral nutrition? (Select all that apply.)

A) Amount of parenteral insulin is adjusted based on the previous 24-hour laboratory values.
B) Insulin may be added to a parenteral nutrition solution.
C) Subcutaneous insulin is used on a sliding scale during parenteral nutrition.
D) Supplemental insulin is rarely required for patients receiving parenteral nutrition.

Question 23

The correct order of actions for a patient starting enteral nutrition with a feeding tube is: _______________,_______________,_______________,_______________,_______________.(Put a comma and space between each solve choice.)

A)Initiate tube feeding.
B)Insert feeding tube.
C)Flush tube to verify patency.
D)Obtain chest radiograph.
E)Assess residuals.

Question 24

The best nursing approach to prevent feeding tube obstruction is:

A) dilute the feeding to make it flow more easily.
B) flush the tube every 4 hours with 20 to 30 mL of tap water.
C) pass a stylet daily to keep the tubing clear.
D) use a larger bore tube where possible.

Question 25

Which intervention(s)is (are)critical during intravenous lipid administration? (Select all that apply).

A) Assess glucose levels.
B) Change the tubing every 24 hours.
C) Hold lipids when administering antibiotics through the same line.
D) Monitor triglyceride levels.

Question 26

Which statement(s)about total parenteral nutrition is (are)true? (Select all that apply.)

A) Assessing fluid volume status and preventing infection are important nursing considerations.
B) Fingerstick glucose levels are assessed every 6 hours and prn.
C) Total parenteral nutrition is administered through a feeding tube and pump.
D) Total parenteral nutrition, with added lipids, provides adequate levels of protein, carbohydrates, and fats.

Question 27

Calorie-dense feedings: (Select all that apply.)

A) are most useful in heart failure and liver disease.
B) are most useful in malabsorption syndromes.
C) contain 2 kcal/mL and 70 g protein/L.
D) include increased fiber.

Question 28

A patient,who has a tube feeding,requires a chest x-ray study for evaluation of a cough.To reduce the risk of aspiration,the nurse:

A) helps the radiology technician to position the patient to avoid dislodging the tube.
B) holds feedings until placement has been verified.
C) slows the infusion rate by half.
D) stops feedings 10 to 15 minutes before placing flat to obtain the radiograph.

Question 29

Risks of total parenteral nutrition include: (Select all that apply.)

A) diarrhea.
B) elevated blood sugar.
C) infection at the catheter site.
D) volume overload.

Question 30

Malnutrition contributes to infection risk by:

A) hampering normal gastrointestinal motility.
B) impairing immune function.
C) increasing blood glucose.
D) increasing drug interactions.