Question 1

The nurse is caring for a patient who is receiving total parenteral nutrition (TPN)and notes that the patient becomes dyspneic when transferring from the bed to a chair.The nurse auscultates rales in both lungs.Which action will the nurse take next?

Accepted Answer

The patient who is being treated with TPN and has dyspnea and rales is experiencing fluid overload.The nurse should slow the rate of the TPN and request an order for a diuretic.Patients perform the Valsalva maneuver during bag changes to help prevent pulmonary emboli.Patients receiving TPN are not necessarily at risk for aspiration pneumonia.Intravenous isotonic dextrose is given after sudden interruption of TPN to prevent hypoglycemia.

Question 2

The nurse is preparing to administer enteral nutrition to a patient who has had a stroke and who cannot swallow.A family member asks why the patient is not receiving intravenous nutrition.What information will the nurse provide to the family member?

Accepted Answer

Total parenteral nutrition (TPN)carries a greater risk of sepsis than enteral nutrition.TPN can provide sufficient calories,and there is no increased risk of aspiration with TPN.TPN does not increase the risk of dehydration.

Question 3

The nurse is caring for a patient with severe burns who will begin receiving total parenteral nutrition (TPN).The patient asks why TPN is necessary.The nurse explains that TPN is used for which reason?

Accepted Answer

TPN is indicated for patients with severe burns who are in negative nitrogen balance.TPN enhances wound healing and provides the nutrients necessary to prevent cellular catabolism.While some pulmonary complications,such as aspiration pneumonia,do not occur with TPN,there is a risk of air embolism.Hyperglycemia and fluid overload may occur.

Question 4

The nurse is caring for a patient who is being treated with total parenteral nutrition (TPN).The patient is experiencing chest pain,and the nurse observes shortness of breath and coughing along with cyanosis.The nurse understands that this patient is most likely experiencing which condition?

Accepted Answer

Patients receiving TPN are at risk for air embolism and will report chest pain and be dyspneic with coughing and cyanosis.Patients with pneumonia will have cough and either adventitious breath sounds or diminished breath sounds.Patients with pneumothorax will have unilateral absent breath sounds and respiratory distress.Patients with pulmonary edema will have crackles and dyspnea.

Question 5

A patient who has been receiving continuous enteral nutrition has had several large,watery stools.The nurse will contact the provider to discuss which intervention?

Accepted Answer

The most common cause of diarrhea during a feeding is dumping syndrome as a result of rapid feed infusion.Slowing the feeding is the appropriate initial action.Antidiarrheal medications are not indicated unless slowing the infusion fails.Total parenteral nutrition is not indicated for patients with a functioning gastrointestinal tract.Thickening the solution will increase the solute load and increase the risk for diarrhea.

Question 6

The nurse is preparing to discontinue total parenteral nutrition (TPN)therapy for a patient who has been receiving TPN for several days.The nurse will contact the provider to discuss an order for

Accepted Answer

Abruptly discontinuing TPN can lead to hypoglycemia.Patients should receive an isotonic dextrose solution for 12 to 24 hours after TPN is discontinued to prevent this reaction.Antibiotics are used when signs of infection are observed.Intravenous insulin would compound hypoglycemia.Nasogastric feedings are indicated if the patient needs continued feeding therapy and has an intact GI tract.

Question 7

A patient who has been receiving total parenteral nutrition (TPN)for several days accidently removes the intravenous (IV)line.While waiting for the IV therapy nurse,the nurse caring for this patient will monitor for which complication?

Accepted Answer

Sudden interruption of TPN therapy can lead to hypoglycemia because of the sudden drop in glucose and the patient's continued increased insulin levels.Air embolism is a complication associated with changing TPN bags.Dehydration is not a complication of a sudden interruption of TPN.Infection is an ongoing concern,but the risk does not increase with a sudden interruption of TPN.

Question 8

The nurse is preparing to hang a new bag for a patient who is receiving total parenteral nutrition (TPN).During this procedure,the nurse will instruct the patient to take a deep breath and then perform which action?

Accepted Answer

The Valsalva maneuver is performed by taking a breath,holding it,and bearing down.Patients are instructed to perform this maneuver in order to prevent the formation of air emboli.

Question 9

The nurse is caring for a patient who is receiving total parenteral nutrition (TPN).The nurse will carefully monitor this patient for which symptom(s)?

Accepted Answer

TPN with IV therapy is prone to air embolism.Symptoms of air embolism are coughing and dyspnea.Decreased breath sounds occur with aspiration,which is a complication of nasogastric feedings.Diarrhea,nausea,and abdominal distension occur with nasogastric feedings.

Question 10

The nurse is preparing to administer enteral nutrition to a patient.Which assessment finding would prompt the nurse to hold the nutrition and notify the patient's provider?

Accepted Answer

Enteral nutrition requires adequate small bowel function with digestion,absorption,and gastrointestinal motility.The nurse should assess for abdominal distension and a decrease or absence of bowel sounds.Patients may still receive enteral feedings if hypotension,cough,or elevated temperature are present.

Question 11

The provider calculates the enteral nutrition needs for a non-ambulatory patient and determines that the patient will need 300 mL of Ultracal every 4 hours.Which method of delivery will the nurse use to administer these feedings?

Accepted Answer

Intermittent enteral feedings are an inexpensive and safe method of administering enteral nutrition and may be used when patients are non-ambulatory.Three hundred to 400 mL of solution may be given and should infuse over 30 to 60 minutes.While bolus methods may be used for patients receiving 250 to 400 mL of solution,this method is not tolerated well by non-ambulatory patients and may cause nausea,vomiting,aspiration,abdominal cramping,and diarrhea.Continuous feedings are used for critically ill patients.Gravity feedings cannot be well controlled and may infuse too fast or too slow.

Question 12

The nurse is caring for an adult with severe burns who weighs 60 kg.Prior to initiating total parenteral nutrition (TPN)therapy,the nurse reviews the orders.Which TPN order is correct for this patient?

Accepted Answer

The recommended energy intake is 25 to 35 kcal/kg/day; critically ill patients require 50% more than the normal energy requirements (approximately 3000 calories per day).Patients should receive 30-35 to 60-55 kcal/kg/day and 1 to 2 g/kg/day of amino acids.For a 60-kg patient,the number of calories should be 1800-2100 to 3600-3300 kcal/day,and amino acids should be 60 to 120 g/day.

Question 13

The nurse assumes care for a patient who is being treated with enteral feeding.When performing the initial assessment,the nurse finds the patient supine and asleep.The nurse will perform which action?

Accepted Answer

When administering an enteral feeding,the nurse should elevate the head of the patient's bed 30 degrees.

Question 14

The nurse is preparing to administer an enteral feeding to a patient who receives 300 mL of Isocal over 30 minutes every 4 hours.The nurse checks the residual prior to initiating the feeding and notes a residual amount of 50 mL of formula.Which action will the nurse take next?

Accepted Answer

The nurse should determine gastric residual before each feeding when patients are receiving intermittent feedings.A residual greater than 50% of a previous feeding indicates delayed gastric emptying and warrants notifying the provider.This patient has a residual less than 50%,so the nurse may proceed with the next feeding.A residual of 100 to 150 mL is significant in patients receiving continuous enteral feedings.The nurse cannot change the rate of an enteral infusion without an order from the provider.

Question 15

The nurse is preparing a patient who will receive intermittent enteral nutrition at home with a hyper-osmolar solution.What information will the nurse include when teaching this patient?

Accepted Answer

Dehydration can occur if patients do not receive enough water during or between feedings,so patients should be taught to consume extra water.The Valsalva maneuver is taught to patients who receive TPN to prevent embolus.Enteral feedings can cause diarrhea,so decreased fiber may aggravate that.

Question 16

A patient receiving total parenteral nutrition (TPN)begins having cough and dyspnea.The nurse auscultates rales and notes neck vein engorgement and weight gain.The nurse suspects that the patient is experiencing which condition?

Accepted Answer

This patient shows signs of overload,characterized by pulmonary edema with cough and dyspnea,neck vein engorgement,and weight gain.

Question 17

The nurse assumes care of a patient who has been receiving intermittent enteral feedings of 240 mL of Osmolite every 4 hours for the past 48 hours.The patient is in bed with the head of the bed elevated 60 degrees.The enteral tubing is intact,and the enteral pump is infusing at 320 mL per hour.The nurse notes 60 mL of solution left in the bag.The tubing is not labeled.What will the nurse do?

Accepted Answer

All enteral equipment should be labeled and changed every 24 hours.Since the tubing is not labeled,the nurse should change and label it as soon as the current infusion is complete.The infusion is set so that 240 mL will infuse over 45 minutes,which is appropriate,so the rate does not need to be increased.The head of the bed should be at least 30 degrees,so there is no need to lower the head of the bed.The nurse should check for residual just prior to administering the next infusion,but it is not indicated at this point.

Question 18

The nurse dilutes an antibiotic before administering it through a patient's nasogastric tube.The patient asks why this is necessary.The nurse explains that diluting the antibiotic helps to

Accepted Answer

Liquid medication must be properly diluted when given through a feeding tube because most liquid medications are hyper-osmolar and can cause abdominal distention,cramping,vomiting,and diarrhea.Diluting the liquid medication does not change absorption,improve overall hydration,or prevent embolus formation.

Question 19

The nurse is caring for a patient who is receiving total parenteral nutrition (TPN).The patient reports nausea,headache,and thirst.The nurse will contact the provider to discuss

Accepted Answer

This patient shows signs of hyperglycemia,which is a common adverse effect of TPN.The nurse should request an order for serum glucose.Symptoms should not be treated without first determining the underlying cause.Isotonic dextrose is given to prevent hypoglycemia.

Question 20

Which patient is most likely to be a candidate for total parenteral nutrition (TPN)rather than enteral nutrition?

Accepted Answer

The patient who is vomiting will be unable to tolerate enteral nutrition.Enteral feedings require a functioning gastrointestinal tract.TPN is more costly and does not carry significant benefits when compared with risks,so it should only be used when enteral nutrition cannot be used.

Quiz 14: Nutritional Support

The nurse is caring for a patient who is receiving total parenteral nutrition (TPN) and notes that the patient becomes dyspneic when transferring from the bed to a chair.The nurse auscultates rales in both lungs.Which action will the nurse take next?

The nurse is preparing to administer enteral nutrition to a patient who has had a stroke and who cannot swallow.A family member asks why the patient is not receiving intravenous nutrition.What information will the nurse provide to the family member?

The nurse is caring for a patient with severe burns who will begin receiving total parenteral nutrition (TPN) .The patient asks why TPN is necessary.The nurse explains that TPN is used for which reason?

The nurse is caring for a patient who is being treated with total parenteral nutrition (TPN) .The patient is experiencing chest pain,and the nurse observes shortness of breath and coughing along with cyanosis.The nurse understands that this patient is most likely experiencing which condition?

A patient who has been receiving continuous enteral nutrition has had several large,watery stools.The nurse will contact the provider to discuss which intervention?

The nurse is preparing to discontinue total parenteral nutrition (TPN) therapy for a patient who has been receiving TPN for several days.The nurse will contact the provider to discuss an order for

A patient who has been receiving total parenteral nutrition (TPN) for several days accidently removes the intravenous (IV) line.While waiting for the IV therapy nurse,the nurse caring for this patient will monitor for which complication?

The nurse is preparing to hang a new bag for a patient who is receiving total parenteral nutrition (TPN) .During this procedure,the nurse will instruct the patient to take a deep breath and then perform which action?

The nurse is caring for a patient who is receiving total parenteral nutrition (TPN) .The nurse will carefully monitor this patient for which symptom(s) ?

The nurse is preparing to administer enteral nutrition to a patient.Which assessment finding would prompt the nurse to hold the nutrition and notify the patient's provider?

The provider calculates the enteral nutrition needs for a non-ambulatory patient and determines that the patient will need 300 mL of Ultracal every 4 hours.Which method of delivery will the nurse use to administer these feedings?

The nurse is caring for an adult with severe burns who weighs 60 kg.Prior to initiating total parenteral nutrition (TPN) therapy,the nurse reviews the orders.Which TPN order is correct for this patient?

The nurse assumes care for a patient who is being treated with enteral feeding.When performing the initial assessment,the nurse finds the patient supine and asleep.The nurse will perform which action?

The nurse is preparing to administer an enteral feeding to a patient who receives 300 mL of Isocal over 30 minutes every 4 hours.The nurse checks the residual prior to initiating the feeding and notes a residual amount of 50 mL of formula.Which action will the nurse take next?

The nurse is preparing a patient who will receive intermittent enteral nutrition at home with a hyper-osmolar solution.What information will the nurse include when teaching this patient?

A patient receiving total parenteral nutrition (TPN) begins having cough and dyspnea.The nurse auscultates rales and notes neck vein engorgement and weight gain.The nurse suspects that the patient is experiencing which condition?

The nurse dilutes an antibiotic before administering it through a patient's nasogastric tube.The patient asks why this is necessary.The nurse explains that diluting the antibiotic helps to

The nurse is caring for a patient who is receiving total parenteral nutrition (TPN) .The patient reports nausea,headache,and thirst.The nurse will contact the provider to discuss

Which patient is most likely to be a candidate for total parenteral nutrition (TPN) rather than enteral nutrition?