Deck 39: Nutritional Problems

Question 1

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

A)A 40-yr-old woman whose parenteral nutrition infusion bag has 30 minutes of solution left
B)A 40-yr-old man with continuous enteral feedings who has developed pulmonary crackles
C)A 30-yr-old man with 4+ generalized pitting edema and severe protein-calorie malnutrition
D)A 30-yr-old woman whose gastrostomy tube is plugged after crushed medications were administered

Answer 1

A 40-yr-old man with continuous enteral feedings who has developed pulmonary crackles

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?

A)The patient uses laxatives daily.
B)The patient's knuckles are macerated.
C)The patient has a history of extreme fluctuations.
D)The patient's serum potassium level is 2.9 mEq/L.

Answer 2

The patient's serum potassium level is 2.9 mEq/L.

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?

A)Keep the patient positioned on the left side.
B)Check the gastric residual volume every 4 to 6 hours.
C)Avoid giving bolus tube feedings through the PEG tube.
D)Obtain a daily abdominal radiographs to verify tube placement.

Answer 3

Check the gastric residual volume every 4 to 6 hours.

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?

A)53
B)66
C)75
D)98

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

A)iron.
B)protein.
C)calories.
D)carbohydrate.

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?

A)Teach the patient about the importance of good nutrition.
B)Serve multiple small feedings of high-calorie, high-protein foods.
C)Consult with the health care provider about parenteral nutrition (PN).
D)Obtain an order for enteral feedings of liquid nutritional supplements.

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)?

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

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?

A)Add a new container of PN using the current tubing and filter.
B)Hang a new container of PN and change the IV tubing and filter.
C)Infuse the remaining 50 mL and then hang a new container of PN.
D)Ask the health care provider to clarify the written PN prescription.

Question 9

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

A)Paresthesias
B)Ecchymoses
C)Dry, scaly skin
D)Gingival swelling

Question 10

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

A)Baked fish with applesauce
B)Beef noodle soup and canned corn
C)Fresh fruit salad with yogurt topping
D)Fried chicken with potatoes and gravy

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?

A)Order six small meals daily.
B)Make a referral to the dietitian.
C)Teach the patient about high-calorie foods.
D)Have family members bring favorite 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?

A)Ask the health care provider to reschedule the scan.
B)Shut the feeding off 30 to 60 minutes before the scan.
C)Connect the feeding tube to continuous suction before and during the scan.
D)Send a suction catheter with the patient in case of aspiration during the scan.

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?

A)Restlessness
B)Hypertension
C)Pitting edema
D)Food allergies

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?

A)Serum albumin level is 3.5 mg/dL.
B)Fluid intake and output are balanced.
C)Surgical incision is healing normally.
D)Blood glucose is less than 110 mg/dL.

Question 15

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

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

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?

A)Risk for activity intolerance
B)Risk for electrolyte imbalance
C)Ineffective health maintenance
D)Imbalanced nutrition: less than body requirements

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

A)obtain a venous blood glucose specimen.
B)slow the infusion rate of the PN infusion.
C)recheck the capillary blood glucose level in 4 to 6 hours.
D)contact the health care provider for infusion rate changes.

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?

A)Ask the daughter about the patient's food preferences.
B)Determine who shops for groceries and prepares the meals.
C)Question the patient about how many meals per day are eaten.
D)Assure the patient that culturally preferred foods will be included.

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?

A)Monitor the patient's capillary blood glucose every 6 hours.
B)Infuse 5% dextrose in water until a new PN bag is delivered.
C)Decrease the PN infusion rate to 10 mL/hr until a new bag arrives.
D)Flush the peripheral line with saline until a new PN bag is available.

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?

A)Slow the infusion rate of the tube feeding.
B)Check gastric residual volumes more frequently.
C)Change the enteral feeding system and formula every 8 hours.
D)Discontinue administration of water through the feeding tube.

Question 21

Which of the nurse's assigned patients should be referred to the dietitian for a complete nutritional assessment ?

A)A 48-yr-old patient with rheumatoid arthritis who takes prednisone daily
B)A 23-yr-old patient who has a history of fluctuating weight gains and losses
C)A 35-yr-old patient who complains of intermittent nausea for the past 2 days
D)A 64-yr-old patient who is admitted for débridement of an infected surgical wound
E)A 52-yr-old patient admitted with chest pain and possible myocardial infarction (MI)

Question 22

The nurse is caring for a 47-yr-old female patient who is comatose and is receiving continuous enteral nutrition 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 action? (Put a comma and a space between each answer choice [A,B,C,D].)

A)Check the patient's oxygen saturation.
B)Notify the patient's health care provider.
C)Measure the tube feeding residual volume.
D)Stop administering the continuous feeding.

Question 23

The nurse is planning care for a patient who is chronically malnourished. Which action is appropriate for the nurse to delegate to unlicensed assistive personnel (UAP)?

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

Question 24

A severely malnourished patient reports that he is Jewish. The nurse's initial action to meet his nutritional needs will be to

A)have family members bring in food.
B)ask the patient about food preferences.
C)teach the patient about nutritious Kosher foods.
D)order nutrition supplements that are manufactured Kosher.