Question 1

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

Accepted Answer

Prealbumin is the most sensitive indicator of protein synthesis and catabolism.

Question 2

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

Accepted Answer

When nutritional goals are not being met,the patient experiences weight loss,elevated glucose levels,and either overhydration or dehydration.

Question 3

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?

Accepted Answer

Medications should not be infused through the IV line infusing parenteral nutrition.The other actions are correct.

Question 4

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?

Accepted Answer

Added fiber helps to control blood glucose and reduce hyperlipidemia.

Question 5

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

Accepted Answer

Abdominal distension is expected if the feedings are not being absorbed.Tympany occurs along with distension.

Question 6

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?

Accepted Answer

Correct placement must be verified by radiograph before use of the tube for either feeding or administering medications.There is no reason to cap the tube and wait; once placement is verified,the tube can be used.

Question 7

The best nursing approach to prevent feeding tube obstruction is to

Accepted Answer

Flushing the tubing every 4 hours helps prevent obstruction.Diluting tube feedings can cause water intoxication.Stylets are never used to clear a tube,and the smallest bore possible should be used for best tolerance.

Question 8

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

Accepted Answer

Total parenteral nutrition is administered through a central intravenous line,such as the subclavian vein.Arteries are never used.The femoral site is avoided.The basilic vein is not a central site.

Question 9

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

Accepted Answer

The head of the bed should be kept elevated at least 30 degrees if possible during tube feedings to minimize reflux.Blue dye should not be used.Neither continuous feedings nor checking for residual will minimize aspiration.

Question 10

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?

Accepted Answer

Patients who are on a ventilator and who are receiving tube feedings are at a high risk for aspiration and ventilator-associated pneumonia.Assessment of tube placement will neither determine presence of paralytic ileus nor maintain patency.Assessment of tube placement is performed to minimize aspiration risk,not skin breakdown on the nose.

Question 11

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?

Accepted Answer

Because of the high dextrose concentration,including the fluid and electrolyte content,the patient is placed at high risk for sepsis and fluid and electrolyte imbalances.Aspiration pneumonia is a potential complication of enteral feedings; sepsis is a potential complication of parenteral nutrition.Fluid overload is possible but unlikely and is not a major complication of parenteral nutrition.Hyperglycemia is more of a concern than hypoglycemia with parenteral nutrition; however,renal insufficiency is not related to parenteral nutrition.

Question 12

An important nutritional consideration in the elderly population is

Accepted Answer

Patients taking multiple medications have a greater potential for drug-nutrient interactions; older adults may be taking multiple medications.

Question 13

A critically ill patient has a nonhealing wound and malnutrition.Which component of nutritional supplementation is most important for this patient to receive?

Accepted Answer

Vitamin A is vital for wound healing.Arginine is also important in wound healing but is more important for trauma and septic patients,as are omega-3 fatty acids.Branched-chain amino acids are very important for stressed patients who have liver dysfunction or ARDS.

Question 14

A patient who is receiving continuous enteral feedings has just vomited 250 mL of milky green fluid.What action by the nurse takes priority?

Accepted Answer

Nausea and vomiting are signs of tube feeding intolerance.The nurse should first stop the feeding.Then the nurse can assess for other signs of intolerance and aspiration.After a complete assessment,the nurse would notify the provider.

Question 15

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?

Accepted Answer

Bioavailability of phenytoin is reduced when administered with enteral feedings.The other drugs do not have significant drug-nutrient interactions.

Question 16

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

Accepted Answer

Enteral feedings prevent bacterial overgrowth and potential bacterial translocation from the gastrointestinal tract and preserve the gut mucosa.

Question 17

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

Accepted Answer

Patients receiving enteral nutrition who develop diarrhea are evaluated for antibiotic- associated causes,including Clostridium difficile.

Question 18

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

Accepted Answer

The ileum is where protein is broken down and absorbed; the patient with ileitis would be at greatest risk for protein malabsorption.

Question 19

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

Accepted Answer

Mucosal villi replenish every 3 to 4 days; without nutritional stimulation,they atrophy.The other statements are false.

Question 20

A patient is receiving enteral feedings and reports fullness and abdominal discomfort.What action by the nurse is best?

Accepted Answer

The patient may not be tolerating the tube feeding.The nurse should assess the gastric residual and hold the feeding if it is greater than 500 mL.The other actions are not warranted; the nurse needs further information before proceeding.

Quiz 6: Nutritional Support