Nutrititional Problems Flashcards
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
A. Paresthesias (B12)
A 76-yr-old woman with a body mass index (BMI) of 17 kg/m2 and a low serum albumin level is being admitted. Which assessment finding will the nurse expect?
a. Restlessness
b. Hypertension
c. Pitting edema
d. Food allergies
ANS: C
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.
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
ANS: D
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.
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. What should the nurse encourage the patient to increase in the diet?
a. Iron
b. Protein
c. Calories
d. Carbohydrate
ANS: B
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.
A patient who has just been started on enteral nutrition of full-strength formula at 100 mL/hr has 6 liquid stools the first day. Which action should the nurse plan to take?
a. Slow the infusion rate of the feeding.
b. Check gastric residual volumes more often.
c. Change the enteral feeding system and formula every 8 hours.
d. Discontinue administration of water through the feeding tube.
ANS: A
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.
A young adult with extensive facial injuries from a motor vehicle crash is receiving continuous enteral nutrition through a percutaneous endoscopic gastrostomy (PEG). Which action will the nurse include in the plan of care?
a. Keep the patient positioned lying on the left side.
b. Flush the tube with 30 mL of water every 4 hours.
c. Crush and mix medications in with the feeding formula.
d. Obtain a daily abdominal radiograph to verify tube placement.
ANS: B
The tube is flushed every 4 hours during continuous feedings to avoid tube obstruction.
The patient should be positioned with the head of the bed elevated. Crushed medications mixed in with the formula are likely to clog the tube. An x-ray is obtained immediately after placement of the PEG tube to check position, but daily x-rays are not needed.
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 should the nurse 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.
ANS: B
All PN solutions and tubings are changed at 24 hours. Infusion of the additional 50 mL will increase patient risk for infection.
The nurse (not the health care provider) is responsible for knowing the indicated times for tubing and filter changes.
A patient’s capillary blood glucose level is 120 mg/dL 6 hours after the nurse initiated a parenteral nutrition (PN) infusion. What is the appropriate action by the nurse?
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.
ANS: C
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.
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.
ANS: C
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.
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. Ask family members to bring favorite foods.
ANS: D
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.
What action should the nurse take when caring for a patient with a soft, silicone nasogastric tube in place for enteral nutrition?
a. Avoid giving medications through the feeding tube.
b. Keep head of bed elevated to 30- to 45-degree angle.
c. Replace the tube every 3 days to avoid mucosal damage.
d. Administer medications mixed with enteral feeding formula.
ANS: B
Elevate the head of the bed to decrease the risk of aspiration. 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. Do not mix medications with formula, as the combination can clog the tube.
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.
ANS: B
The 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.
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
ANS: B
The patient data suggest aspiration may have 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.
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.
ANS: B
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.
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. Difficulty coping
b. Disturbed body image
c. Impaired nutritional status
d. Risk for electrolyte imbalance
ANS: D
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.
