Deck 40: Nursing Management: Nutritional Problems

Question 1

A patient who has a wound infection after major surgery has only been taking in about 50% to 75% of the ordered meals and states, "Nothing on the menu really appeals to me." Which action by the nurse will be most effective in improving the patient's oral intake?

A) Order at least six small meals daily.
B) Have family members bring in favorite foods from home.
C) Teach the patient about high-calorie, high-protein foods.
D) Make a referral to the dietician.

Answer 1

Have family members bring in favorite foods from home.

Question 2

In evaluating a patient outcome of "chooses high-protein foods," the nurse knows the outcome has been met when for lunch the patient selects from the hospital menu

A) bacon and tomato sandwich, bean soup, and coffee with cream.
B) peanut butter and jelly sandwich, French fries, and whole milk.
C) barbequed chicken breast sandwich, fruit yogurt, and skim milk.
D) chicken noodle soup, grilled cheese sandwich, and apple juice.

Answer 2

barbequed chicken breast sandwich, fruit yogurt, and skim milk.

Question 3

Parenteral nutrition (PN) containing amino acids and dextrose was ordered and hung 24 hours ago for a malnourished patient. The nurse observes that about 50 ml remaining in the PN container. Which action is appropriate at this time?

A) Infuse the remaining 50 ml and then hang a new container of PN.
B) Hang a new container of PN and change the IV tubing and filter.
C) Continue to use the same tubing and filter and hang a new container of PN.
D) Clarify with the health care provider if the new PN also requires a tubing and filter change.

Answer 3

Continue to use the same tubing and filter and hang a new container of PN.

Question 4

PN with a peripherally inserted central catheter (PICC) is initiated for a patient. After 6 hours of PN infusion, the nurse checks the patient's capillary blood glucose level and finds it to be 140 mg/dl (8.9 mmol/L). The most appropriate action by the nurse is to

A) notify the health care provider of the glucose level.
B) recheck the capillary blood glucose in 4 hours.
C) obtain a venous blood glucose specimen.
D) slow the infusion rate of the PN infusion.

Question 5

A 72-year-old patient with massive infection is 5 ft 2 in (155 cm) tall and weighs 92 pounds (42 kg). Laboratory results include hemoglobin 10.5 g/dl (105 g/L) and albumin 2.0 g/dl (20 g/L). Which additional information will be most useful when the nurse is determining the patient's nutritional status?

A) Blood pressure
B) Level of consciousness
C) Presence of edema
D) Food allergies

Question 6

An 82-year-old Latino patient with mild protein-calorie malnutrition shares a home with his spouse and adult daughter. When developing a teaching plan to improve the patient's nutrition, it will be most important for the nurse to obtain information about

A) food preferences of the spouse and adult child.
B) who shops for groceries and cooks.
C) the number of meals per day the patient eats.
D) foods that are culturally significant for the patient.

Question 7

A patient with protein-calorie malnutrition has undergone surgery and radiation therapy for a malignant tumor of the bowel. The health care provider orders PN for the patient. The nurse will evaluate that the PN is effective when the patient's

A) blood glucose is 110 mg/dl.
B) fluid intake and output are balanced.
C) surgical incision is healing normally.
D) serum albumin level is 3.7 mg/dl.

Question 8

All these nursing actions are included in the plan of care for a patient who is malnourished. Which action is appropriate for the nurse to delegate to a nursing assistant?

A) Offer the patient the ordered nutritional supplement between meals.
B) Assess the patient's strength while ambulating the patient in the room.
C) Monitor the patient for skin breakdown over the bony prominences.
D) Assist the patient to choose high-nutrition items from the menu.

Question 9

A 22-year-old patient is admitted to the hospital with anorexia nervosa. The patient is 5 ft 5 in (163 cm) tall and weighs 90 pounds (41 kg). Laboratory tests reveal hypokalemia and iron-deficiency anemia. In planning care for the patient, the nurse places the highest priority on the nursing diagnosis of

A) ineffective health maintenance related to obsession with body image.
B) risk for decreased cardiac output related to electrolyte imbalance.
C) imbalanced nutrition: less than body requirements related to refusal to eat.
D) risk for activity intolerance related to anemia and weakness.

Question 10

A 66-year-old patient recovering from surgery for cancer of the lung is thin and has an albumin level of 3.7 g/dl (37 g/L). The nurse will plan to teach the patient about

A) the need to increase protein intake during the patient's hospitalization period.
B) the requirement for high-protein and high-calorie foods for at least several weeks.
C) selecting foods that are high in protein but relatively low in calories.
D) picking protein-rich foods that are also low in calories derived from fat.

Question 11

A patient with bulimia is admitted to the hospital with electrolyte disorders. Which patient behavior observed by the nurse is of most concern?

A) The patient only eats about 20% of breakfast.
B) The patient ambulates continuously in the hallway.
C) The patient goes into the bathroom after each meal.
D) The patient asks for laxatives to treat constipation.

Question 12

A patient with difficulty swallowing is started on continuous tube feedings of a full-strength commercial formula at 100 ml/hr. The patient has six diarrhea stools the first day. The action that is most appropriate for the nurse to take first is to

A) slow the tube feeding flow rate.
B) discontinue any water intake.
C) notify the health care provider about the need for a change in formula.
D) check residuals and hold feedings if any residual is found.

Question 13

When using a nutrition screening tool, the nurse can identify a patient at nutritional risk without further assessment when the patient has

A) pressure ulcers.
B) had a recent hip fracture.
C) been vomiting for 3 days.
D) had recent surgery.

Question 14

The hospital nurse educator is observing a new RN who is caring for a patient receiving PN through a single-lumen central line inserted in the right subclavian vein. Which action by the new RN indicates that the RN can safely care for the patient?

A) The new RN flushes the line after drawing a blood specimen.
B) The new RN reminds the patient to keep the right arm straight.
C) The new RN checks capillary blood glucose every 8 hours.
D) The new RN infuses the PN solution using an infusion pump.

Question 15

The nurse teaches a patient who is being stabilized on a therapeutic dose of warfarin (Coumadin) not to alter the normal dietary intake of green, leafy vegetables, dairy products, or meats, primarily because these foods

A) are a source of vitamin K and may alter the action of warfarin.
B) decrease the absorption of warfarin.
C) have a natural anticoagulant effect.
D) affect the activity of bowel bacteria responsible for vitamin K production.

Question 16

A patient is receiving continuous tube feedings through a percutaneous endoscopic gastrostomy (PEG). To maintain safe and effective delivery of the tube feeding, the nurse should

A) flush the tube with 50 ml of water every 8 hours after checking for residual volume.
B) obtain a daily radiograph for verification of tube placement.
C) check tube placement and residual volume every 4-6 hours.
D) place the patient on the left side with the head of the bed elevated to 45 degrees.

Question 17

During assessment of a patient who is a vegan, the nurse observes for signs of nutritional deficiency. The most common nutritional deficiency related to a strict vegan diet would be manifested by

A) muscle wasting.
B) bleeding gums.
C) pallor and changes in sensation and movement of the extremities.
D) dry, scaly skin and cracked, painful oral mucous membranes.

Question 18

A patient who weighs 145 pounds (66 kg) asks the nurse how much protein should be included in the daily diet. The nurse recommends that the diet should include a minimum of _____ g protein.

A) 36
B) 53
C) 75
D) 98

Question 19

While caring for an older adult patient hospitalized with dehydration and moderate protein-calorie malnutrition (PCM), the nurse identifies a nursing diagnosis of risk for infection related to

A) decreased leukocyte activity and phagocytosis.
B) anemia of malnutrition.
C) muscle weakness and impaired coughing effort.
D) delayed wound healing.

Question 20

A high-calorie, high-protein diet is provided for a patient with a fractured hip and severe protein-calorie depletion, but the patient eats only about 50% of each meal tray and then complains of feeling tired. The nurse will plan to

A) arrange for smaller portions to be served on patient trays.
B) serve multiple small feedings of high-calorie, high-protein foods.
C) give continuous tube feedings of liquid nutritional supplements.
D) administer intravenous feeding with parenteral nutrition solutions.

Question 21

Which of these nursing actions included in the plan of care for a patient who is receiving intermittent tube feedings through a PEG tube may be delegated to an LPN/LVN?

A) Teaching the patient and family how to administer tube feedings
B) Assessing the patient's nutritional status at least weekly
C) Determining the need for the addition of water to the feedings
D) Providing skin care to the area around the tube site

Question 22

While caring for a comatose patient who is receiving continuous tube feedings through a soft nasogastric tube, the nurse notes the presence of new crackles in the patient's lungs. In which order will the nurse take the following actions?

A) Obtain the patient's oxygen saturation.
B) Turn off the tube feeding.
C) Notify the patient's health care provider.
D) Check the tube feeding residual volume.

Question 23

During a busy day, the nurse admits all of these patients to the medical-surgical unit. Which patients are most important to refer to the dietician for a complete nutritional assessment? (Select all that apply.)

A) A 24-year-old admitted with multiple leg fractures after an automobile accident
B) A 32-year-old admitted for eye surgery and has a history of diabetes
C) A 45-year-old admitted with chest pain and possible myocardial infarction (MI)
D) A 53-year-old who complains of intermittent nausea for the past 2 days
E) A 66-year-old who is admitted for débridement of an infected surgical wound
Correct

Question 24

The nurse notes that the peripheral PN bag is almost empty and a new PN bag has not yet arrived from the pharmacy. Which action is appropriate?

A) Decreasing the rate of the current PN infusion to 10 ml/hr until the new bag arrives
B) Infusing 5% dextrose in water until the new PN bag is delivered from the pharmacy
C) Flushing the peripheral line with saline and wait until the new PN bag is available
D) Monitoring the patient's capillary blood glucose until a new PN bag is hung

Question 25

A patient who is receiving a continuous tube feeding through a small-bore silicone feeding tube has a computed tomography (CT) scan ordered and will have to be placed in a flat position for the scan. The nurse will plan to

A) ask the health care provider to reschedule the CT scan.
B) send the patient to CT scan with oral suction in case of aspiration.
C) shut the feeding off 30 to 60 minutes before the scan.
D) connect the feeding tube to continuous suction during the scan.

Question 26

When using a soft, silicone nasogastric tube for enteral feedings, the nurse will need to

A) flush the tubing after checking for residual volumes.
B) administer continuous feedings using an infusion pump.
C) replace the tube every 3 to 5 days to avoid mucosal damage.
D) avoid giving medications through the feeding tube.