Question 1

After change-of-shift report,which patient will the nurse assess first?

Accepted Answer

The patient data suggest aspiration has occurred,and rapid assessment and intervention are needed. The other patients should also be assessed soon,but the data about them do not suggest any immediately life-threatening complications.

Question 2

A 20-yr-old woman is being admitted with electrolyte disorders of unknown etiology. Which assessment finding is most important to report to the health care provider?

Accepted Answer

The low serum potassium level may cause life-threatening cardiac dysrhythmias,and potassium supplementation is needed rapidly. The other information will also be reported because it suggests that bulimia may be the etiology of the patient's electrolyte disturbances,but it does not suggest imminent life-threatening complications.

Question 3

A young adult with extensive facial injuries from a motor vehicle crash is receiving tube feedings through a percutaneous endoscopic gastrostomy (PEG). Which action will the nurse include in the plan of care?

Accepted Answer

The gastric residual volume is assessed every 4 to 6 hours to decrease the risk for aspiration. The patient does not need to be positioned on the left side. Bolus feedings can be administered through a PEG tube. An x-ray is obtained immediately after placement of the PEG tube to check position,but daily are not needed.

Question 4

A healthy adult woman who weighs 145 lb (66 kg)asks the clinic nurse about the minimum daily requirement for protein. How many grams of protein will the nurse recommend?

Accepted Answer

The recommended daily protein intake is 0.8 to 1 g/kg of body weight. Therefore,the minimum for this patient is 66 kg * 0.8 g = 52.8 or 53 g/day.

Question 5

A patient has a body mass index (BMI)of 31 kg/m²,a normal C-reactive protein level,and low serum transferrin and albumin levels. The nurse will plan patient teaching to increase the patient's intake of foods that are high in

Accepted Answer

The patient's C-reactive protein and transferrin levels indicate low protein stores. The BMI is in the obese range,so increasing caloric intake is not indicated. The data do not indicate a need for increased carbohydrate or iron intake.

Question 6

A patient hospitalized with chronic heart failure eats only about 50% of each meal and reports "feeling too tired to eat." Which action should the nurse take first?

Accepted Answer

Eating small amounts of food frequently throughout the day is less fatiguing and will improve the patient's ability to take in more nutrients. Teaching the patient may be appropriate,but will not address the patient's inability to eat more because of fatigue. Tube feedings or PN may be needed if the patient is unable to take in enough nutrients orally,but increasing the oral intake should be attempted first.

Question 7

Which action for a patient receiving tube feedings through a percutaneous endoscopic gastrostomy (PEG)may be delegated to a licensed practical/vocational nurse (LPN/LVN)?

Accepted Answer

LPN/LVN education and scope of practice include actions such as dressing changes and wound care. Patient teaching and complex assessments (such as patient nutrition and hydration status)require registered nurse (RN)-level education and scope of practice.

Question 8

A malnourished patient is receiving a parenteral nutrition (PN)infusion containing amino acids and dextrose from a bag that was hung with a new tubing and filter 24 hours ago. The nurse observes that about 50 mL remain in the PN container. Which action is best for the nurse to take?

Accepted Answer

All PN solutions are changed at 24 hours. PN solutions containing dextrose and amino acids require a change in tubing and filter every 72 hours rather than daily. Infusion of the additional 50 mL will increase patient risk for infection. Changing the IV tubing and filter more frequently than required will unnecessarily increase costs. The nurse (not the health care provider)is responsible for knowing the indicated times for tubing and filter changes.

Question 9

Which finding for a young adult who follows a vegan diet may indicate the need for cobalamin supplementation?

Accepted Answer

Cobalamin (vitamin B₁₂)cannot be obtained from foods of plant origin,so the patient will be most at risk for signs of cobalamin deficiency,such as paresthesias,peripheral neuropathy,and anemia. The other symptoms listed are associated with other nutritional deficiencies but would not be associated with a vegan diet.

Question 10

Which menu choice best indicates that the patient is implementing the nurse's suggestion to choose high-calorie,high-protein foods?

Accepted Answer

Foods that are high in calories include fried foods and those covered with sauces. High-protein foods include meat and dairy products. The other choices are lower in calories and protein.

Question 11

A 60-yr-old man who is hospitalized with an abdominal wound infection has been eating very little and states,"Nothing on the menu sounds good." Which action by the nurse will be most effective in improving the patient's oral intake?

Accepted Answer

The patient's statement that the hospital foods are unappealing indicates that favorite home-cooked foods might improve intake. The other interventions may also help improve the patient's intake,but the most effective action will be to offer the patient more appealing foods.

Question 12

A patient is receiving continuous enteral nutrition through a small-bore silicone feeding tube. What should the nurse plan for when this patient has a computed tomography (CT)scan ordered?

Accepted Answer

The tube feeding should be shut off 30 to 60 minutes before any procedure requiring the patient to lie flat. Because the CT scan is ordered for diagnosis of patient problems,rescheduling is not usually an option. Prevention,rather than treatment,of aspiration is needed. Small-bore feeding tubes are soft and collapse easily with aspiration or suction,making nasogastric suction of gastric contents unreliable.

Question 13

A 76-yr-old woman with a body mass index (BMI)of 17 kg/m² and a low serum albumin level is being admitted by the nurse. Which assessment finding will the nurse expect to find?

Accepted Answer

Edema occurs when serum albumin levels and plasma oncotic pressure decrease. The blood pressure and level of consciousness are not directly affected by malnutrition. Food allergies are not an indicator of nutritional status.

Question 14

After abdominal surgery,a patient with protein calorie malnutrition is receiving parenteral nutrition (PN). Which is the best indicator that the patient is receiving adequate nutrition?

Accepted Answer

Because poor wound healing is a possible complication of malnutrition for this patient,normal healing of the incision is an indicator of the effectiveness of the PN in providing adequate nutrition. Blood glucose is monitored to prevent the complications of hyperglycemia and hypoglycemia,but it does not indicate that the patient's nutrition is adequate. The intake and output will be monitored,but do not indicate that the PN is effective. The albumin level is in the low-normal range but does not reflect adequate caloric intake,which is also important for the patient.

Question 15

When caring for a patient with a soft,silicone nasogastric tube in place for enteral feedings,the nurse will

Accepted Answer

The soft silicone feeding tubes are small in diameter and can easily become clogged unless they are flushed after the nurse checks the residual volume. Either intermittent or continuous feedings can be given. The tubes are less likely to cause mucosal damage than the stiffer polyvinyl chloride tubes used for nasogastric suction and do not need to be replaced at certain intervals. Medications can be given through these tubes,but flushing after medication administration is important to avoid clogging.

Question 16

A 19-yr-old woman admitted with anorexia nervosa is 5 ft,6 in (163 cm)tall and weighs 88 lb (41 kg). Laboratory tests reveal hypokalemia and iron-deficiency anemia. Which patient problem has the highest priority?

Accepted Answer

The patient's hypokalemia may lead to life-threatening cardiac dysrhythmias. The other diagnoses are also appropriate for this patient but are not associated with immediate risk for fatal complications.

Question 17

A patient's capillary blood glucose level is 120 mg/dL 6 hours after the nurse initiated a parenteral nutrition (PN)infusion. The appropriate action by the nurse is to

Accepted Answer

Mild hyperglycemia is expected during the first few days after PN is started and requires ongoing monitoring. Because the glucose elevation is small and expected,infusion rate changes are not needed. There is no need to obtain a venous specimen for comparison. Slowing the rate of the infusion is beyond the nurse's scope of practice and will decrease the patient's nutritional intake.

Question 18

Which action should the nurse take first when preparing to teach a frail 79-yr-old Hispanic man who lives with an adult daughter about ways to improve nutrition?

Accepted Answer

The family member who shops for groceries and cooks will be in control of the patient's diet,so the nurse will need to ensure that this family member is involved in any teaching or discussion about the patient's nutritional needs. The other information will also be assessed and used but will not be useful in meeting the patient's nutritional needs unless nutritionally appropriate foods are purchased and prepared.

Question 19

A patient's peripheral parenteral nutrition (PN)bag is nearly empty,and a new PN bag has not arrived yet from the pharmacy. Which intervention by the nurse is appropriate?

Accepted Answer

To prevent hypoglycemia,the nurse should infuse a 5% dextrose solution until the next peripheral PN bag can be started. Decreasing the rate of the ordered PN infusion is beyond the nurse's scope of practice. Flushing the line and then waiting for the next bag may lead to hypoglycemia. Monitoring the capillary blood glucose every 6 hours would not identify hypoglycemia while awaiting the new PN bag.

Question 20

A patient who has just been started on tube feedings of full-strength formula at 100 mL/hr has 6 diarrhea stools the first day. Which action should the nurse plan to take?

Accepted Answer

Loose stools indicate poor absorption of nutrients and indicate a need to slow the feeding rate or decrease the concentration of the feeding. Water should be given when patients receive enteral feedings to prevent dehydration. When a closed enteral feeding system is used,the tubing and formula are changed every 24 hours. High residual volumes do not contribute to diarrhea.

Quiz 39: Nutritional Problems

After change-of-shift report,which patient will the nurse assess first?

A 20-yr-old woman is being admitted with electrolyte disorders of unknown etiology. Which assessment finding is most important to report to the health care provider?

A young adult with extensive facial injuries from a motor vehicle crash is receiving tube feedings through a percutaneous endoscopic gastrostomy (PEG) . Which action will the nurse include in the plan of care?

A healthy adult woman who weighs 145 lb (66 kg) asks the clinic nurse about the minimum daily requirement for protein. How many grams of protein will the nurse recommend?

A patient has a body mass index (BMI) of 31 kg/m²,a normal C-reactive protein level,and low serum transferrin and albumin levels. The nurse will plan patient teaching to increase the patient's intake of foods that are high in

A patient hospitalized with chronic heart failure eats only about 50% of each meal and reports "feeling too tired to eat." Which action should the nurse take first?

Which action for a patient receiving tube feedings through a percutaneous endoscopic gastrostomy (PEG) may be delegated to a licensed practical/vocational nurse (LPN/LVN) ?

A malnourished patient is receiving a parenteral nutrition (PN) infusion containing amino acids and dextrose from a bag that was hung with a new tubing and filter 24 hours ago. The nurse observes that about 50 mL remain in the PN container. Which action is best for the nurse to take?

Which finding for a young adult who follows a vegan diet may indicate the need for cobalamin supplementation?

Which menu choice best indicates that the patient is implementing the nurse's suggestion to choose high-calorie,high-protein foods?

A 60-yr-old man who is hospitalized with an abdominal wound infection has been eating very little and states,"Nothing on the menu sounds good." Which action by the nurse will be most effective in improving the patient's oral intake?

A patient is receiving continuous enteral nutrition through a small-bore silicone feeding tube. What should the nurse plan for when this patient has a computed tomography (CT) scan ordered?

A 76-yr-old woman with a body mass index (BMI) of 17 kg/m² and a low serum albumin level is being admitted by the nurse. Which assessment finding will the nurse expect to find?

After abdominal surgery,a patient with protein calorie malnutrition is receiving parenteral nutrition (PN) . Which is the best indicator that the patient is receiving adequate nutrition?

When caring for a patient with a soft,silicone nasogastric tube in place for enteral feedings,the nurse will

A 19-yr-old woman admitted with anorexia nervosa is 5 ft,6 in (163 cm) tall and weighs 88 lb (41 kg) . Laboratory tests reveal hypokalemia and iron-deficiency anemia. Which patient problem has the highest priority?

A patient's capillary blood glucose level is 120 mg/dL 6 hours after the nurse initiated a parenteral nutrition (PN) infusion. The appropriate action by the nurse is to

Which action should the nurse take first when preparing to teach a frail 79-yr-old Hispanic man who lives with an adult daughter about ways to improve nutrition?

A patient's peripheral parenteral nutrition (PN) bag is nearly empty,and a new PN bag has not arrived yet from the pharmacy. Which intervention by the nurse is appropriate?

A patient who has just been started on tube feedings of full-strength formula at 100 mL/hr has 6 diarrhea stools the first day. Which action should the nurse plan to take?