Question 1

The nurse is caring for an older adult client who is weak and has not been eating due to lack of strength. Which task could the nurse safely assign to the assistive personnel (AP)?&#10;A) Completing a nutritional screening&#10;B) Determining why the client is feeling weak&#10;C) Using therapeutic communication with the client to determine if psychosocial factors are influencing the ability to eat&#10;D) Assisting the client with eating meals

Accepted Answer

1. The AP can assist the client to eat but should be taught to encourage the client to do as much as possible for himself. Nutritional screening, assessment for cause of weakness, and therapeutic communication are roles for the nurse, not the AP.
2. The AP can assist the client to eat but should be taught to encourage the client to do as much as possible for himself. Nutritional screening, assessment for cause of weakness, and therapeutic communication are roles for the nurse, not the AP.
3. The AP can assist the client to eat but should be taught to encourage the client to do as much as possible for himself. Nutritional screening, assessment for cause of weakness, and therapeutic communication are roles for the nurse, not the AP.
4. The AP can assist the client to eat but should be taught to encourage the client to do as much as possible for himself. Nutritional screening, assessment for cause of weakness, and therapeutic communication are roles for the nurse, not the AP.

Question 2

When administering a bolus enteral feeding, which information can the nurse safely omit when documenting?&#10;A) Stomach residual found prior to administering the feedings&#10;B) Calories contained within the feeding&#10;C) Client tolerance or concerns&#10;D) Type and quantity of feeding administered

Accepted Answer

1. Although some facilities might have nurses calculate calories administered per day for clients with tube feedings, this is not routinely recorded with each feeding. All other information should be included following each feeding.
2. Although some facilities might have nurses calculate calories administered per day for clients with tube feedings, this is not routinely recorded with each feeding. All other information should be included following each feeding.
3. Although some facilities might have nurses calculate calories administered per day for clients with tube feedings, this is not routinely recorded with each feeding. All other information should be included following each feeding.
4. Although some facilities might have nurses calculate calories administered per day for clients with tube feedings, this is not routinely recorded with each feeding. All other information should be included following each feeding.

Question 3

A client reports difficulty swallowing and having no appetite. For which nutritional issue should the nurse assess this client?&#10;A) Overnutrition&#10;B) Undernutrition&#10;C) Bulimia nervosa&#10;D) Protein-calorie malnutrition (PCM)

Accepted Answer

1. Overnutrition refers to a caloric intake in excess of daily energy requirements, resulting in storage of energy in the form of increased adipose (fat) tissue.
2. Undernutrition refers to an intake of nutrients insufficient to meet daily energy requirements as a result of inadequate food intake or improper digestion and absorption of food. An inadequate food intake may be caused by dysphagia (difficulty swallowing) or anorexia (loss of appetite).
3. Bulimia nervosa is a mental health problem that does not cause difficulty swallowing or loss of appetite.
4. Characteristics of PCM are depressed visceral proteins, weight loss, and visible muscle and fat wasting.

Question 4

The nurse is assigning tasks to assistive personnel (AP). Which information should the nurse review with the AP before assigning a client to feed?&#10;A) Stand next to the bed during the meal&#10;B) Explain that toileting can occur after the meal&#10;C) Assist the client to a position conducive to eating&#10;D) Suggest the client avoid participating during the meal

Accepted Answer

1. The AP should be in a seated position near the client.
2. Toileting should occur before the meal.
3. The client should be in a position that is conducive to eating.
4. The client should be encouraged to participate during the meal.

Question 5

A client is recovering from esophageal and stomach surgery. Which feeding approach should the nurse anticipate for this client?&#10;A) Nasogastric&#10;B) Jejunostomy&#10;C) Gastrostomy&#10;D) Nasointestinal

Accepted Answer

1. Because the client had esophageal and stomach surgery, a nasogastric tube would not be appropriate.
2. Because the client had esophageal and stomach surgery, a jejunostomy tube would be appropriate.
3. Because the client had esophageal and stomach surgery, a gastrostomy tube would not be appropriate.
4. Because the client had esophageal and stomach surgery, a nasointestinal tube would not be appropriate.

Question 6

A client is being started on intermittent enteral feedings. How much formula should the nurse provide for the first feeding?&#10;A) 120 mL&#10;B) 240 mL&#10;C) 360 mL&#10;D) 500 mL

Accepted Answer

1. Initial intermittent feedings should be no more than 120 mL. If tolerated, the amount is increased by 120 mL each feeding until the goal amount is reached.
2. Initial intermittent feedings should be no more than 120 mL. If tolerated, the amount is increased by 120 mL each feeding until the goal amount is reached.
3. Initial intermittent feedings should be no more than 120 mL. If tolerated, the amount is increased by 120 mL each feeding until the goal amount is reached.
4. Initial intermittent feedings should be no more than 120 mL. If tolerated, the amount is increased by 120 mL each feeding until the goal amount is reached.

Question 7

A client is prescribed cyclic feedings to be administered at night. Which should the nurse particularly assess in this client?&#10;A) Heart rate&#10;B) Pulse oximeter&#10;C) Blood pressure&#10;D) Intake and output

Accepted Answer

1. There is no reason to particularly assess this client's heart rate.
2. There is no reason to particularly assess this client's pulse oximeter.
3. There is no reason to particularly assess this client's blood pressure.
4. Because nocturnal feedings may use higher nutrient densities and higher infusion rates than the standard continuous feeding, particular attention needs to be given to monitoring fluid status or intake and output.

Question 8

A client is prescribed an infusion of intralipids. Which action should the nurse take when providing this nutritional supplement?&#10;A) Wait for a central line to be inserted&#10;B) Insert a 14 gauge catheter in the client&#10;C) Provide the lipids through a peripheral catheter&#10;D) Wait for a peripherally inserted central line to be placed

Accepted Answer

1. A central line is not required to infuse intralipids.
2. A 14 gauge catheter is not required to infuse intralipids.
3. Peripheral parenteral nutrition (PPN), delivered into the smaller peripheral veins, cannot handle as concentrated a solution as central lines but can accommodate lipids.
4. A peripherally inserted central line is not required to infuse intralipids.

Question 9

A client is receiving total parenteral nutrition (TPN) through a central vascular access device. Which should the nurse document when caring for this client? Select all that apply.&#10;A) Daily weight&#10;B) Skin integrity&#10;C) Rate of infusion&#10;D) Vital signs q 4 hours&#10;E) Capillary blood glucose level

Accepted Answer

1. When caring for a client receiving TPN, daily weights should be documented.
2. Skin integrity is not a priority when caring for a client receiving TPN.
3. When caring for a client receiving TPN, the rate of infusion should be documented.
4. When caring for a client receiving TPN, vital signs every 4 hours should be documented.
5. When caring for a client receiving TPN, capillary blood glucose level should be documented.

Deck 19: Feeding Clients