Chapter 27: Diet Therapy and Assisted Feeding My Nursing Test Banks

Chapter 27: Diet Therapy and Assisted Feeding

Test Bank

MULTIPLE CHOICE

1. Before any diet tray is delivered to a patient, the nurse has the responsibility of:

a.

determining if the patient needs assistance to eat.

b.

confirming the diet on the tray with the diet sheet.

c.

assessing if the food is of the appropriate temperature.

d.

adding extra salt and sugar packets.

ANS: B

The diet tray should be checked against the diet order to be sure that the patient receives the proper diet. No matter who actually delivers the tray, it is the nurse who confirms the accuracy of the diet.

DIF: Cognitive Level: Comprehension REF: p. 478, Skill 27-1

OBJ: Theory #1 TOP: Nurse Role KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: basic care and comfort

2. The nutritional documentation that is most informative is:

a.

ate all of lunch.

b.

ate 50% of lunch without difficulty. Refused all solid food.

c.

drank most of liquids without difficulty.

d.

assisted feeding liquid diet, choked frequently.

ANS: B

Nutritional documentation should include percentage of intake and how it is tolerated.

DIF: Cognitive Level: Application REF: p. 478 OBJ: Theory #1

TOP: Nutrition Documentation KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: basic care and comfort

3. When assisting a patient with a severe visual impairment who wishes to feed himself, the nurse could best facilitate the patients eating by:

a.

placing the plate on his lap.

b.

seating the patient in a chair and placing the over-the-bed table appropriately.

c.

orienting the patient to the position of foods on the plate using a clock-face description.

d.

placing each food in a separate container or bowl.

ANS: C

It is best to orient a visually impaired patient to the position of the foods on the plate by describing the plate as if it is a clock face (3 oclock, 6 oclock, and so on).

DIF: Cognitive Level: Application REF: p. 479, Skill 27-1

OBJ: Theory #1 TOP: Assisting Patient with Eating

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: basic care and comfort

4. A patient who underwent surgery has an order to begin a clear-liquid diet and can be offered:

a.

tea with milk.

b.

Jell-O.

c.

cream soup.

d.

fruit sherbet.

ANS: B

A clear-liquid diet consists of foods that are liquid at room temperature and are clear, have a low residue, and are easily digested. Gelatins are part of a clear liquid diet.

DIF: Cognitive Level: Comprehension REF: p. 480 OBJ: Theory #2

TOP: Diet for Postoperative Patient KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: basic care and comfort

5. A nurse caring for a patient with bulimia should add to the care plan to assess for:

a.

hiding food in napkins or under plate.

b.

inducing self to vomit.

c.

refusal to eat.

d.

flushing food down commode.

ANS: B

With bulimia, along with binge eating, there is purging, fasting, and the use of laxatives. These patients may eat everything on their tray then purge by inducing themselves to vomit.

DIF: Cognitive Level: Comprehension REF: p. 481 OBJ: Theory #3

TOP: Bulimia KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: basic care and comfort

6. An obese clinic patient who is in the latter part of the first trimester of a pregnancy asks how much weight she should gain. The nurses best response is to say that the total weight gain should be no more than _____ pounds.

a.

35

b.

30

c.

20

d.

10

ANS: C

Total weight gain for an obese patient should be no more than 20 pounds.

DIF: Cognitive Level: Comprehension REF: p. 482, Table 27-1

OBJ: Theory #4 TOP: Pregnancy KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance: prevention and early detection of disease

7. The nurse takes into consideration that a patient who abuses alcohol is at risk for a vitamin deficiency in:

a.

thiamine.

b.

cyanocobalamin.

c.

ascorbic acid.

d.

iron.

ANS: A

Thiamine deficiency is often present in patients who abuse alcohol.

DIF: Cognitive Level: Knowledge REF: p. 481 OBJ: Theory #4

TOP: Substance Abuse KEY: Nursing Process Step: Planning

MSC: NCLEX: Health Promotion and Maintenance: prevention and early detection of disease

8. A patient who is on a low-cholesterol diet verbalizes that he enjoys eating meats and doesnt intend to stop. The nurses most helpful response would be, You can enjoy your meat if you will concentrate on such meats as:

a.

broiled sirloin steak.

b.

fried catfish.

c.

baked turkey breast.

d.

sausage patties.

ANS: C

Red meat, eggs, and high-fat dairy products contain large amounts of saturated fat; poultry (such as turkey breast) and fish are low-fat items and therefore are desirable when trying to reduce serum cholesterol. Fried foods also contain extra cholesterol.

DIF: Cognitive Level: Comprehension REF: p. 483 OBJ: Theory #4

TOP: Patient Education KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance: prevention and early detection of disease

9. An older male patient is concerned about his cholesterol lab report that shows an elevated high-density lipoprotein (HDL) level. The nurse explains that such a report indicates that:

a.

he should go on a strenuous low-cholesterol diet.

b.

he is at risk for hypertension.

c.

is developing atherosclerosis.

d.

his vessels are being cleansed of fatty deposits.

ANS: D

High-density lipoprotein (HDL) is the good cholesterol that tends to cleanse the vessels of fatty deposits.

DIF: Cognitive Level: Comprehension REF: p. 483 OBJ: Theory #4

TOP: HDL KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance: prevention and early detection of disease

10. An outpatient clinic nurse assesses a blood glucose level of 75 mg/dL in a patient who has been on a low-carbohydrate diet for the last 10 days. The nurse should:

a.

notify the physician about the ineffectiveness of the diet.

b.

document the finding.

c.

suggest a moderate increase carbohydrate intake.

d.

arrange a dietician consultation to discuss a more effective diet.

ANS: B

Document the finding. Normal blood sugar is between 70 and 120 mg/dL.

DIF: Cognitive Level: Application REF: p. 484 OBJ: Theory #5

TOP: Disease Process Benefiting from Diet Therapy

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance: prevention and early detection of disease

11. Because of the patients dysphagia, the nurse recommends to the physician that the patient be placed on a Level II texture level diet, which means that the food is:

a.

thickened to prevent aspiration.

b.

pureed to a pudding consistency.

c.

mechanically altered, moist, minced helpings.

d.

minced into bite-size pieces.

ANS: C

Level II texture is a diet in which the food has been mechanically altered to moist, -inch pieces.

DIF: Cognitive Level: Comprehension REF: p. 486 OBJ: Theory #3

TOP: Dietary Modifications KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: reduction of risk

12. A nurse positions a patient for the insertion of a nasogastric (NG) tube by:

a.

turning the patient to a right side-lying position.

b.

sitting the patient upright and hyperextending the patients head.

c.

lowering the head of the bed to a flat position.

d.

raising the head of the bed to 30 degrees.

ANS: B

The head of the bed should be raised and the patient asked to hyperextend his head to facilitate the passage of the NG tube.

DIF: Cognitive Level: Application REF: p. 489, Skill 27-2

OBJ: Theory #6 TOP: NG Tube Insertion

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: reduction of risk

13. The nurse who is preparing to give a feeding per a nasogastric (NG) tube tests the placement of the tube most safely by:

a.

checking the lungs for rhonchi.

b.

instilling 10 mL of normal saline and checking for cough.

c.

aspirating stomach contents.

d.

injecting 20 mL of air and listen at the tip of the xiphoid.

ANS: C

The safest and most assured method to test for NG tube placement is to aspirate stomach contents and check fluid for pH. Using the air method is not as accurate as the stomach aspiration.

DIF: Cognitive Level: Application REF: p. 495, Skill 27-4

OBJ: Clinical Practice #3 TOP: NG Tube Insertion

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: reduction of risk

14. Stopping the infusion and checking for residual, the nurse aspirates 155 mL of gastric contents. The nurse should next:

a.

replace the aspirate and continue with the feeding.

b.

throw the aspirate away and flush the tubing.

c.

replace the aspirate and stop feeding for 1 to 2 hours.

d.

throw the aspirate away and stop feeding for 2 hours.

ANS: C

If the residual volume is greater than 150 mL, the fluid should be replaced, and further feeding should be delayed by 1 to 2 hours, or agency policy should be followed.

DIF: Cognitive Level: Application REF: p. 493 OBJ: Clinical Practice #4

TOP: Residual KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: basic care and comfort

15. A patient is scheduled to receive an intermittent tube feeding. This feeding should be allowed to flow in over how many minutes?

a.

1

b.

2

c.

5

d.

10

ANS: D

An intermittent feeding should take approximately 10 minutes to flow into the tube.

DIF: Cognitive Level: Comprehension REF: p. 493 OBJ: Theory #7

TOP: Tube Feeding KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: reduction of risk

16. When the patient has just finished receiving a tube feeding, the nurse leaves the head of the patients bed elevated for 30 to 60 minutes after feeding in order to:

a.

facilitate stomach emptying and prevent aspiration.

b.

maintain skin integrity to the buttocks.

c.

facilitate lung drainage and promote ventilation.

d.

prevent feeding tube from clogging.

ANS: A

The head of the bed should be left elevated at a 30- to 90- degree angle for 30 to 60 minutes after the feeding to help reduce the risk of aspiration.

DIF: Cognitive Level: Comprehension REF: p. 49, Box 27-3

OBJ: Clinical Practice #4 TOP: Tube Feeding

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: reduction of risk

17. The nurse caring for the patient receiving total parenteral nutrition (TPN) should monitor the flow rate every _____ hours.

a.

2

b.

3

c.

4

d.

6

ANS: C

Both the IV site and the flow rate should be monitored every 4 hours and the site assessed for infection.

DIF: Cognitive Level: Knowledge REF: p. 497, Table 27-4

OBJ: Theory #8 TOP: TPN KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: basic care and comfort

18. The nurse explains that adequate vitamin D can be acquired by:

a.

eating 2 oranges a day every week.

b.

eating fish 3 times a week.

c.

having 10 minutes of sunshine on the limbs.

d.

eating green leafy vegetables.

ANS: C

Exposing the limbs to 10 minutes of sunshine daily can provide adequate vitamin D.

DIF: Cognitive Level: Comprehension REF: p. 483 OBJ: Theory #5

TOP: Vitamin D KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: basic care and comfort

19. The nurse is caring for a patient who has total parenteral nutrition (TPN) running finds that the infusion is behind by 200 mL. The nurse should:

a.

increase the flow rate 5% until the infusion has caught up.

b.

check the patients stomach residual.

c.

elevate the head of the bed 30 degrees.

d.

document the discrepancy and report to the charge nurse.

ANS: D

The rate of a TPN is never increased because of the danger of causing hyperglycemia or circulatory overload. The discrepancy is to be documented and reported to the charge nurse or physician.

DIF: Cognitive Level: Application REF: p. 497 OBJ: Theory #1

TOP: Monitoring TPN KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: basic care and comfort

20. A patient recently started on enteral tube feedings starts complaining of nausea and having diarrhea. The best nursing action is to:

a.

check the enteral tube for placement.

b.

slow down the feedings and monitor.

c.

perform a fingerstick blood glucose test.

d.

stop the feedings and inform the physician.

ANS: D

Nausea, constipation, and diarrhea are concerns following institution of tube feedings.

DIF: Cognitive Level: Application REF: p. 497, Box 27-3

OBJ: Clinical Practice #4 TOP: Enteral Nutrition

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: basic care and comfort

21. A patient has a new order to have an NG tube removed. The nurse should initially:

a.

wash her hands and apply clean gloves.

b.

encourage mouth care as needed.

c.

explain the procedure to the patient.

d.

pinch the tube while removing it.

ANS: C

Explaining the procedure to the patient before starting helps in gaining the patients confidence.

DIF: Cognitive Level: Application REF: p. 492, Steps 27-2

OBJ: Clinical Practice #3 TOP: NG Tube Removal

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Safe Effective Care Environment

22. A nurse is instructing a family member who will be caring for a patient receiving enteral feedings after discharge to home. The nurse would emphasize:

a.

taping the gastrostomy tube so that it does not hang lower than the stomach.

b.

discarding unused opened refrigerated formula after 3 to 4 days.

c.

administering tube feedings while they are still cold from the refrigerator.

d.

mixing all medications together for administration at the same time.

ANS: A

The tube should be taped so that it is higher than the entry point into the body.

DIF: Cognitive Level: Application REF: p. 498, Patient Teaching

OBJ: Clinical Practice #2 TOP: Health Teaching

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: basic care and comfort

23. The nurse inserting an NG tube through the nostril into the back of the throat of a patient would instruct the patient to:

a.

hyperextend the head.

b.

cough forcefully.

c.

drop head forward and begin to swallow.

d.

open mouth and extend tongue.

ANS: C

The patient should be instructed to tip the head forward and begin to swallow to help advance the tube through the esophagus.

DIF: Cognitive Level: Application REF: p. 490, Skill 27-2

OBJ: Clinical Practice #3 TOP: NG Tube Insertion

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Safe Effective Care Environment

24. The nurse caring for a patient receiving enteral feedings would assess for tolerance of the feeding by monitoring:

a.

for gastric tube patency.

b.

for duodenal tube patency.

c.

for abdominal distention.

d.

the rate of the feeding.

ANS: C

Assessing the abdomen for distention helps the nurse identify intolerance of tube feedings.

DIF: Cognitive Level: Application REF: p. 494, Skill 27-3

OBJ: Clinical Practice #4 TOP: Enteral Nutrition

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: basic care and comfort

25. While the nurse is explaining the procedure for inserting a tube for enteral feedings, the patient interrupts and asks why there is a need for this tube. The nurses best response is:

a.

Your physician has ordered this to help your condition.

b.

Tell me what your doctor told you about this procedure.

c.

Are you telling me you dont want this tube inserted?

d.

This tube placement will only be temporary.

ANS: B

In assessing the patients understanding, the nurse should assess the level of the patients understanding and knowledge about the procedure.

DIF: Cognitive Level: Application REF: p. 497 OBJ: Clinical Practice #3

TOP: NG Tube Insertion KEY: Nursing Process Step: Assessment

MSC: NCLEX: Psychosocial Integrity: basic care and comfort

26. When caring for a patient receiving total parenteral nutrition, the nurse knows that it is essential to:

a.

check for flow rate every shift.

b.

order electrolytes daily.

c.

monitor IV site every shift.

d.

monitor for blood glucose.

ANS: D

Total parenteral nutrition contains a high concentration of glucose, and monitoring blood glucose every 6 to 8 hours will determine patient tolerance.

DIF: Cognitive Level: Comprehension REF: p. 497, Box 27-3

OBJ: Theory #10 TOP: TPN KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: reduction of risk

COMPLETION

27. The correct anatomic landmarks to follow when inserting a nasogastric tube is to measure from the __________ to the ___________ and then to the ___________.

ANS:

tip of the nose; tip of the ear; xiphoid process

Using landmarks individualizes the tube length.

DIF: Cognitive Level: Application REF: p. 498, Skill 27-2

OBJ: Clinical Practice #3 TOP: NG Tube Insertion

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: basic care and comfort

28. The nurse recommends to a patient who desires weight reduction to engage in a minimum of ______ minutes of exercise most days of the week.

ANS:

30 minutes

Thirty minutes

Physical exercise of moderate intensity for 30 to 60 minutes most days of the week is an effective support to weight reduction

DIF: Cognitive Level: Comprehension REF: p. 482, Table 27-1

OBJ: Theory #4 TOP: Weight Reduction

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance: prevention and early detection of disease

29. The nurse takes into consideration that excessive intake of saturated and trans-fat leads to the development of fatty deposits being laid down in the walls of the blood vessels and causing ____________.

ANS:

atherosclerosis

Excessive intake of saturated and trans-fat leads to the development of fatty deposits being laid down in the walls of the blood vessels called atherosclerosis.

DIF: Cognitive Level: Knowledge REF: p. 483 OBJ: Theory #4

TOP: Atherosclerosis KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance: prevention and early detection of disease

MULTIPLE RESPONSE

30. A nurse instructs a patient who is to receive a soft diet that the diet will include: (Select all that apply.)

a.

eggs.

b.

multigrain bread.

c.

baked potato.

d.

soups.

e.

fruit juices.

f.

milk products.

ANS: A, D, E, F

Soft diets are low in fiber, and foods have a soft consistency. Foods allowed on a soft diet include eggs, breads without seeds, boiled or mashed potatoes, soups, fruit, juices, tender cooked vegetables, ground meats or meats cooked until soft, cooked cereals, and milk products.

DIF: Cognitive Level: Comprehension REF: p. 480 OBJ: Theory #1

TOP: Nutrition KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: basic care and comfort

31. When the patient complains about the insertion of the total parenteral nutrition (TPN) tube interfering with his movement, the nurse explains that the insertion in the subclavian vein allows: (Select all that apply.)

a.

adequate dilution of TPN solution.

b.

closer proximity to the heart.

c.

more effective monitoring from the IV pump.

d.

for adequate blood flow.

e.

for more ease in dressing insertion site.

ANS: A, D

The placement in the subclavian provides a large vein with large blood flow, which dilutes the TPN to keep venous irritation at a minimum and ensures better distribution.

DIF: Cognitive Level: Application REF: p. 496 OBJ: Theory #10

TOP: Insertion Site KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: basic care and comfort

32. A nurse giving a bolus feeding through a nasogastric tube with a syringe would: (Select all that apply.)

a.

pull up 50 mL of formula in the syringe.

b.

lower the head of the bed to flat position.

c.

allow feeding to flow in by gravity.

d.

flush the tube with 50 mL of water.

e.

check the position of the tube.

ANS: C, E

The nurse should roll up the head of the bed, check the placement of the tube, allow 30 mL of formula to flow in by gravity, and flush the tubing with 30 mL of water.

DIF: Cognitive Level: Application REF: p. 498 OBJ: Theory #2

TOP: Nutrition KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: basic care and comfort

33. A nurse caring for a patient diagnosed with AIDS would include in the nutritional plan of care: (Select all that apply.)

a.

asking the patient about sexual history.

b.

encouraging the patient to eat solid foods high in protein.

c.

offering the patient supplements such as Ensure.

d.

obtaining an order for a dietitian consult.

e.

urging patient to eat three well-balanced meals per day.

f.

offer pureed foods when the patients mouth is painful.

ANS: C, D, F

Solid food may be difficult to eat, so consulting with a dietitian and having the patient eat foods that are high in protein and that are bland or pureed are very appropriate. AIDS patients should eat small meals several times a day.

DIF: Cognitive Level: Application REF: p. 496 OBJ: Theory #3

TOP: HIV/AIDS and Nutrition KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: basic care and comfort

34. The nurse counsels the bulimic patient that her eating disorder can lead to serious conditions such as: (Select all that apply.)

a.

esophageal ulcers.

b.

diverticulitis.

c.

ulcerative colitis.

d.

peptic ulcers.

e.

congestive heart failure.

ANS: A, D

Long-term bulimic patients may acquire serious conditions such as esophageal and peptic ulcers.

DIF: Cognitive Level: Comprehension REF: p. 481 OBJ: Theory #4

TOP: Eating Disorders KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance: prevention and early detection of disease

35. The nurse suggests to a diabetic patient to eat complex carbohydrates, which include: (Select all that apply.)

a.

whole grain foods.

b.

brown rice.

c.

lima beans.

d.

legumes.

e.

sweet potatoes.

ANS: A, B, D

Complex carbohydrates include whole grain foods, brown rice, legumes, and whole grain pasta.

DIF: Cognitive Level: Comprehension REF: p. 484 OBJ: Theory #1

TOP: Complex Carbohydrates KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance: prevention and early detection of disease

36. Fluid overload is suspected in an 82-year-old patient who is receiving total parenteral nutritional therapy (TPN) when the nurse assesses: (Select all that apply.)

a.

excessive urine output.

b.

increased pulse rate.

c.

dyspnea.

d.

hyperactive bowel sounds.

e.

complaint of headache.

ANS: A, B, C

Indications of fluid overload include output exceeding intake, increased pulse rate, dyspnea, cough, and crackles.

DIF: Cognitive Level: Comprehension REF: p. 497, Elder Care

OBJ: Theory #9 TOP: Fluid Overload

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Health Promotion and Maintenance: prevention and early detection of disease

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