chapter 39-nutritional problems

Question 1

1. Which finding for a 19-year-old female who is a vegan may indicate the need for cobalamin supplementation?
   a. Paresthesias
   b. Ecchymoses
   c. Dry, scaly skin
   d. Gingival swelling

Answer 1

A. Paresthesias

Question 2

2. A 76-year-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

Answer 2

C. Pitting edema

Question 3

3. Which menu choice indicates that the patient is implementing plans 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

Answer 3

D. Fried chicken with potatoes and gravy

Question 4

4. A 48-year-old woman 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.

Answer 4

B protein.

Question 5

5. A 48-year-old man 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.

Answer 5

A. Slow the infusion rate of the tube feeding.

Question 6

6. A 20-year-old man 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 x-ray to verify tube placement.

Answer 6

B. Check the gastric residual volume every 4 to 6 hours.

Question 7

7. A malnourished patient is receiving a parenteral nutrition (PN) infusion containing amino acids and dextrose from a bag that was hung 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. Ask the health care provider to clarify the written PN order.
   b. Add a new container of PN using the current tubing and filter.
   c. Hang a new container of PN and change the IV tubing and filter.
   d. Infuse the remaining 50 mL and then hang a new container of PN.

Answer 7

B. Add a new container of PN using the current tubing and filter.

Question 8

8. A patient’s capillary blood glucose level is 120 mg/dL 6 hours after the nurse initiated a parenteral nutrition (PN) infusion. The most 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 in 4 to 6 hours.
   d. notify the health care provider of the glucose level.

Answer 8

C. recheck the capillary blood glucose in 4 to 6 hours.

Question 9

9. 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.

Answer 9

C. Surgical incision is healing normally.

Question 10

10. A 60-year-old man who is hospitalized with an abdominal wound infection has only been eating about 50% of meals 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 in favorite foods.

Answer 10

D. Have family members bring in favorite foods.

Question 11

11. When caring for a 63-year-old woman 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. administer continuous feedings using an infusion pump.
    d. replace the tube every 3 days to avoid mucosal damage.

Answer 11

B. flush the tubing after checking for residual volumes.

Question 12

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. Shut the feeding off 30 to 60 minutes before the scan.
    b. Ask the health care provider to reschedule the CT scan.
    c. Connect the feeding tube to continuous suction during the scan.
    d. Send the patient to CT scan with oral suction in case of aspiration

Answer 12

A. Shut the feeding off 30 to 60 minutes before the scan.

Question 13

13. A healthy 28-year-old woman patient who weighs 145 pounds (66 kg) asks the 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

Answer 13

A. 53

Question 14

14. A 20-year-old female is being admitted for 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’s serum potassium level is 2.9 mEq/L.
    d. The patient has a history of large weight fluctuations.

Answer 14

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

Question 15

15. 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. Providing skin care to the area around the tube site
    b. Teaching the patient how to administer tube feedings
    c. Determining the need for adding water to the feedings
    d. Assessing the patient’s nutritional status at least weekly

Answer 15

A. Providing skin care to the area around the tube site

Question 16

16. Which action should the nurse take first when preparing to teach a frail 79-year-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.

Answer 16

B. Determine who shops for groceries and prepares the meals.

Question 17

17. After change-of-shift report, which patient will the nurse assess first?
    a. A 40-year-old woman whose parenteral nutrition infusion bag has 30 minutes of solution left
    b. A 40-year-old man with continuous enteral feedings who has developed pulmonary crackles
    c. A 30-year-old man with 4+ generalized pitting edema and severe protein-calorie malnutrition
    d. A 30-year-old woman whose gastrostomy tube is plugged after crushed medications were administered.

Answer 17

B. A 40-year-old man with continuous enteral feedings who has developed pulmonary crackles

Question 18

18. 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. Obtain an order for enteral feedings of liquid nutritional supplements.
    d. Consult with the health care provider about providing parenteral nutrition (PN).

Answer 18

B. Serve multiple small feedings of high-calorie, high-protein foods

Question 19

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 is the priority?
    a. Monitor the patient’s capillary blood glucose until a new PN bag is hung.
    b. Flush the peripheral line with saline and wait until the new PN bag is available.
    c. Infuse 5% dextrose in water until the new PN bag is delivered from the pharmacy.
    d. Decrease the rate of the current PN infusion to 10 mL/hr until the new bag arrives.

Answer 19

C. Infuse 5% dextrose in water until the new PN bag is delivered from the pharmacy.

Question 20

20. A 19-year-old female admitted with anorexia nervosa is 5 ft 6 in (163 cm) tall and weighs 88 pounds (41 kg). Laboratory tests reveal hypokalemia and iron-deficiency anemia. Which nursing diagnosis has the highest priority?
    a. Risk for activity intolerance related to anemia
    b. Risk for electrolyte imbalance related to eating patterns
    c. Ineffective health maintenance related to body image obsession
    d. Imbalanced nutrition: less than body requirements related to anorexia

Answer 20

B. Risk for electrolyte imbalance related to eating patterns

Question 21

21. 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.

Answer 21

C. Offer the patient the prescribed nutritional supplement between meals.

Question 22

22. 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.

Answer 22

B. ask the patient about food preferences