Deck 7: Nutrition Alterations and Management

Question 1

A patient with poorly controlled diabetes mellitus is to be started on enteral tube feeding.What type of formula would be most appropriate?

A) Whole proteins and glucose polymers
B) Concentrated in calories
C) Low sodium
D) High fat, low carbohydrate

Answer 1

High fat, low carbohydrate

Question 2

The nursing management plan for a patient at risk for aspiration should include which intervention?

A) Administer intermittent feedings
B) Add thickening agents to the tube feeding solution
C) Suction the patient hourly
D) Elevate the head of the bed 30 to 45 degrees

Answer 2

Elevate the head of the bed 30 to 45 degrees

Question 3

Biochemical and clinical data play an important role in assessing a patient's nutritional status.What laboratory and clinical findings may be present in the patient with cardiovascular disease?

A) Low levels of high-density lipoprotein (HDL) cholesterol and transferrin
B) Elevated low-density lipoprotein (LDL) cholesterol and decreased subcutaneous fat
C) Elevated sodium levels and a soft, fatty liver on palpation
D) Normal triglyceride levels and the presence of S3 on auscultation

Answer 3

Elevated low-density lipoprotein (LDL) cholesterol and decreased subcutaneous fat

Question 4

The loss of exocrine function of pancreatitis results in what disorder?

A) Anorexia
B) Obesity
C) Malabsorption
D) Hyperglycemia

Question 5

Which statement regarding obtaining height and weight measurements for the critically ill patient is accurate?

A) All measurements should be deferred until the patient's medical condition stabilizes.
B) Measurements should be actually measured rather than obtained through patient or family report.
C) Measurements for weight are documented in pounds and height in inches.
D) Measurement of weight is mandatory, but measurement of height can be deferred.

Question 6

A patient on mechanical ventilation is receiving total parenteral nutrition (TPN).Which statement is true?

A) Excessive calorie intake can cause an increase in PaCO₂.
B) The patient's head should remain elevated at 45 degrees to avoid aspiration.
C) Lipid intake should be maintained at greater than 2 g/kg/day.
D) TPN is preferred over the use of enteral feeding to avoid the complication of aspiration.

Question 7

Most of the energy produced from carbohydrate metabolism is used to form what substance?

A) Galactose
B) Glycogen
C) Adenosine triphosphate
D) Antibodies

Question 8

What type of diet would be appropriate for a patient with hypertension after a myocardial infarction?

A) Three meals a day with two snacks
B) Low-protein diet
C) Low-salt, low-cholesterol diet
D) High-carbohydrate diet

Question 9

Proteins are energy-yielding nutrients that provide important structural and functional duties within the body.What is one important physiologic function of proteins?

A) Maintaining osmotic pressure
B) Providing minerals in the body
C) Maintaining blood glucose
D) Providing a stored source of energy

Question 10

Patients with coronary artery disease should be taught about cholesterol.Which situation is most desirable?

A) Low levels of high-density lipoprotein (HDL) cholesterol
B) Low levels of low-density lipoprotein (LDL) cholesterol
C) Hypocholesterolemia
D) Low levels of both HDL and LDL cholesterol

Question 11

What intervention should be included in a nutrition plan for a patient with hypertension?

A) Decreasing carbohydrates
B) Limiting salt
C) Increasing protein
D) Increasing fluids

Question 12

How would a person with a BMI of 28 be classified?

A) Obese
B) Overweight or preobese
C) Normal weight
D) Underweight

Question 13

Two types of protein-caloric malnutrition are kwashiorkor and marasmus.What physiologic changes are associated with Kwashiorkor?

A) Weight loss and muscle wasting
B) Low levels of serum proteins, low lymphocyte count, and hair loss
C) Elevated serum albumin and increased creatinine excretion in the urine
D) Hyperpigmentation and a hard, easily palpated liver margin

Question 14

What is one effect of malnutrition on respiratory system function?

A) Decreased surfactant production
B) Increased vital capacity
C) Decreased carbon dioxide production
D) Increased respiratory rate

Question 15

The patient is receiving corticosteroid treatment for neurologic alterations.The patient should be routinely monitored for what common complication of this type of therapy?

A) Hyponatremia
B) Hyperalbuminemia
C) Hyperkalemia
D) Hyperglycemia

Question 16

A patient who has sustained a head injury has increased nutritional needs related to what physiologic mechanism?

A) Decreased metabolism as a result of coma
B) Decreased blood sugar from a lack of dietary supplementation
C) Anabolism and wound healing
D) Hypermetabolism and catabolism associated with the injury

Question 17

A patient is admitted with severe malnutrition.A central venous catheter is placed in the right subclavian vein and total parenteral nutrition (TPN)is started.For which complication should the patient be evaluated immediately after insertion of the catheter?

A) Pneumothorax
B) Hypoglycemia
C) Central venous thrombosis
D) Pulmonary aspiration

Question 18

A patient has a new order for intermittent nasogastric feedings every 4 hours.The nasogastric tube is placed by the nurse.What is the most accurate method for confirming the placement of the tube before initiating the feeding?

A) Obtain radiography of the abdomen
B) Check the pH of fluid aspirated from the tube
C) Auscultate the left upper quadrant of the abdomen while injecting air into the tube
D) Auscultate the right upper quadrant of the abdomen while injecting air into the tube

Question 19

What is the rationale for careful intake and output for patients with pulmonary alterations?

A) Fluid retention occurs with tachypnea.
B) Hemodilution may cause deleterious hypernatremia.
C) Fluid volume excess can lead to right-sided heart failure.
D) Excessive fluid losses may lead to dehydration and hypovolemic shock.

Question 20

Which of the following nutritional interventions is a priority for the patient with renal disease who is receiving dialysis?

A) Increase fluids to replace losses.
B) Encourage potassium-rich foods to replace losses.
C) Ensure an adequate amount of protein to prevent catabolism.
D) Limit all nutrients to account for altered renal excretion.

Question 21

A patient is mechanically ventilated and is receiving enteral nutrition via a nasogastric tube.To help ensure feeding tolerance,the nurse checks residual volumes every 4 hours.During a residual check later in the shift,the nurse aspirates a total residual volume of 350 mL.What action should the nurse take next?

A) Stop the tube feeding, wait 1 hour, and recheck the residual
B) Discontinue tube feeding and call the practitioner for parenteral nutrition orders
C) Continue the tube feeding if no other gastrointestinal symptoms exist and reassess the patient with the next residual check
D) Continue the tube feeding and place the patient in the left lateral decubitus position to facilitate gastric emptying

Question 22

A tracheostomy patient is experiencing regurgitation of tube feeding formula.What should be the nurse's first priority?

A) Checking to make sure the tracheostomy cuff is inflated during tube feedings
B) Placing the patient in the right lateral decubitus position to promote gastric emptying
C) Discussing the use of metoclopramide to facilitate gastric motility with the practitioner
D) Placing the patient in prone position to improve draining from mouth

Question 23

A patient is admitted with acute liver failure and encephalopathy.Which dietary restrictions should be maintained for the patient?

A) Fat and magnesium
B) Protein and sodium
C) Carbohydrate and potassium
D) Protein and calcium

Question 24

What nutritional alteration is most frequently encountered in hospitalized patients?

A) Respiratory quotient (RQ)
B) Protein-calorie malnutrition
C) Fat-calorie malnutrition
D) Gluconeogenesis

Question 25

A patient with heart failure is placed on a sodium and fluid restriction.What is the purpose of this order?

A) To enhance the metabolize of medications
B) To normalize the patient's weight
C) To reduce cardiac workload
D) To decrease serum lipids

Question 26

Which signs would alert the nurse to possible nutritional alterations?

A) Impaired wound healing
B) Edema
C) Nail growth
D) Muscle atrophy
E) Diaphoresis

Question 27

A patient is admitted with severe malnutrition.A central venous catheter is placed in the right subclavian vein and total parenteral nutrition (TPN)is started.On the third day of infusion,the patient develops symptoms of fever and chills.What complication should the nurse suspect?

A) Air embolism
B) Pneumothorax
C) Central venous thrombosis
D) Catheter-related sepsis

Question 28

A patient is admitted with severe malnutrition.A central venous catheter is placed in the right subclavian vein and total parenteral nutrition (TPN)is started.What medical interventions may be initiated with the onset of hyperglycemia?

A) Discontinuing the infusion
B) Adding insulin to the TPN
C) Weaning from the TPN over a 6-hour period
D) Starting an infusion of 0.9% normal saline

Question 29

A patient is admitted with end-stage renal disease (ESRD)and is on hemodialysis.Which nutritional elements should be restricted?

A) Fluid
B) Protein
C) Carbohydrates
D) Fats
E) Phosphorus

Question 30

A patient is mechanically ventilated and is receiving enteral nutrition via a nasogastric tube.Which intervention should be included the patient's plan of care to prevent clogging of the feeding tube?

A) Flush the tube with gastric juice every 8 hours.
B) Obtain an order for a prokinetic agent to stimulate gastric emptying.
C) Irrigate the tube with water before and after administration of any medication.
D) Add crushed medications to the enteral feeding formula.