Chapter 40: Nursing Management: Nutritional Problems My Nursing Test Banks

Lewis: Medical-Surgical Nursing, 8th Edition

Chapter 40: Nursing Management: Nutritional Problems

Test Bank

MULTIPLE CHOICE

1. When assessing a patient who is a vegan, which finding may indicate the need for cobalamin supplementation?

a.

Paresthesias

b.

Ecchymoses

c.

Dry, scaly skin

d.

Gingival swelling

ANS: A

Cobalamin (vitamin B12) cannot be obtained from foods of plant origin, so the patient will be most at risk for signs of cobalamin deficiency, such as anemia and peripheral neuropathy. The other symptoms listed are associated with other nutritional deficiencies but would not be associated with a vegan diet.

DIF: Cognitive Level: Application REF: 922-923

TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

2. A patient with a body mass index (BMI) of 17 kg/m2 and a low 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

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.

DIF: Cognitive Level: Application REF: 923 | 925

TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

3. Which choice from the hospital menu indicates that the patient has understood the nurses teaching about choosing high calorie, high protein foods?

a.

Baked fish with applesauce

b.

Beef noodle soup and canned corn

c.

Fresh vegetables 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.

DIF: Cognitive Level: Application REF: 929 TOP: Nursing Process: Evaluation

MSC: NCLEX: Physiological Integrity

4. A 66-year-old patient has a body mass index (BMI) of 31 kg/m2, a normal C-reactive protein level, and low transferrin and albumin levels. The nurse will plan patient teaching to increase the patients intake of foods that are high in

a.

iron.

b.

protein.

c.

calories.

d.

carbohydrate.

ANS: B

The patients 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.

DIF: Cognitive Level: Application REF: 925-927 TOP: Nursing Process: Planning

MSC: NCLEX: Physiological Integrity

5. A patient who has just been started on continuous tube feedings of a full-strength commercial formula at 100 mL/hr using a closed system method has six 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.

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.

DIF: Cognitive Level: Application REF: 933-934 TOP: Nursing Process: Planning

MSC: NCLEX: Physiological Integrity

6. A patient 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.

Obtain a daily x-ray to verify tube placement.

c.

Check the gastric residual volume every 4 to 6 hours.

d.

Avoid giving bolus tube feedings through the PEG tube.

ANS: C

The gastric residual volume is assessed every 4 to 6 hours to decrease the risk for aspiration. The patient does not need to be positioned on the left side. An x-ray is obtained immediately after placement of the PEG tube to check position, but daily x-rays are not needed. Bolus feedings can be administered through a PEG tube.

DIF: Cognitive Level: Application REF: 933-934 TOP: Nursing Process: Planning

MSC: NCLEX: Physiological Integrity

7. 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 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.

ANS: B

All PN solutions are changed at 24 hours. PN solutions containing dextrose and amino acids require a change in tubing and filter every 72 hours rather than daily. Infusion of the additional 50 mL will increase patient risk for infection. Changing the IV tubing and filter more frequently than required will unnecessarily increase costs. The nurse (not the health care provider) is responsible for knowing the indicated times for tubing and filter changes.

DIF: Cognitive Level: Application REF: 937

TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

8. After 6 hours of parenteral nutrition (PN) infusion, the nurse checks a patients capillary blood glucose level and finds it to be 120 mg/dL. 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 hours.

d.

notify the health care provider of the glucose level.

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, notification of the health care provider is not necessary. There is no need to obtain a venous specimen for comparison. Slowing the rate of the infusion is beyond the nurses scope of practice and will decrease the patients nutritional intake.

DIF: Cognitive Level: Application REF: 938-939

TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

9. A patient with protein calorie malnutrition who has had abdominal surgery is receiving parenteral nutrition (PN). Which assessment information obtained by the nurse is the best indicator that the patient is receiving adequate nutrition?

a.

Blood glucose is 110 mg/dL.

b.

Serum albumin level is 3.5 mg/dL.

c.

Fluid intake and output are balanced.

d.

Surgical incision is healing normally.

ANS: D

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 patients 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.

DIF: Cognitive Level: Application REF: 928-930 TOP: Nursing Process: Evaluation

MSC: NCLEX: Physiological Integrity

10. 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 patients oral intake?

a.

Make a referral to the dietician.

b.

Order at least six small meals daily.

c.

Teach the patient about high-calorie, high-protein foods.

d.

Have family members bring in favorite foods from home.

ANS: D

The patients statement that the hospital foods are unappealing indicates that favorite home-cooked foods might improve intake. The other interventions also may help improve the patients intake, but the most effective action will be to offer the patient more appealing foods.

DIF: Cognitive Level: Application REF: 929

TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

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

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 to 5 days to avoid mucosal damage.

ANS: B

The soft silicone feeding tubes are small in diameter and can easily become clogged unless they are flushed after the nurse checks the residual volume. Either intermittent or continuous feedings can be given. 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.

DIF: Cognitive Level: Application REF: 931-934

TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

12. A patient who is receiving continuous enteral nutrition 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. Which action by the nurse is best?

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.

ANS: A

The tube 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.

DIF: Cognitive Level: Application REF: 932-933 TOP: Nursing Process: Planning

MSC: NCLEX: Physiological Integrity

13. The nurse is performing an admission assessment on a 20-year-old college student who is being admitted for electrolyte disorders of unknown etiology. Which assessment finding is most important to report to the health care provider?

a.

The patients knuckles are macerated.

b.

The patient uses laxatives on a daily basis.

c.

The patient has a history of weight fluctuations.

d.

The patients serum potassium level is 2.9 mEq/L.

ANS: D

The low serum potassium level may cause life-threatening cardiac dysrhythmias and potassium supplementation is needed rapidly. The other information also will be reported because it suggests that bulimia may be the etiology of the patients electrolyte disturbances, but it does not suggest imminent life-threatening complications.

DIF: Cognitive Level: Application REF: 940-941

OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment

MSC: NCLEX: Physiological Integrity

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

a.

Providing skin care to the area around the tube site

b.

Assessing the patients nutritional status at least weekly

c.

Determining the need for the addition of water to the feedings

d.

Teaching the patient and family how to administer tube feedings

ANS: A

LPN/LVN education and scope of practice include actions such as dressing changes and wound care. Patient teaching and complex assessments (such as patient nutrition and hydration status) require RN-level education and scope of practice.

DIF: Cognitive Level: Application REF: 935

OBJ: Special Questions: Delegation TOP: Nursing Process: Planning

MSC: NCLEX: Safe and Effective Care Environment

15. When preparing to teach an 82-year-old Hispanic patient who lives with an adult daughter about ways to improve nutrition, which action should the nurse take first?

a.

Ask the daughter about the patients 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 appropriate foods will be included.

ANS: B

The family member who shops for groceries and cooks will be in control of the patients diet, so the nurse will need to ensure that this family member is involved in any teaching or discussion about the patients nutritional needs. The other information also will be assessed and used but will not be useful in meeting the patients nutritional needs unless nutritionally appropriate foods are purchased and prepared.

DIF: Cognitive Level: Application REF: 923-924

OBJ: Special Questions: Prioritization TOP: Nursing Process: Planning

MSC: NCLEX: Health Promotion and Maintenance

16. How many grams of protein will the nurse recommend to meet the minimum daily requirement for a patient who weighs 145 pounds (66 kg)?

a.

36

b.

53

c.

75

d.

98

ANS: B

The recommended daily protein intake is 0.8 to 1 g/kg of body weight, which for this patient is 66 kg 0.8 g = 52.8 or 53 g/day.

DIF: Cognitive Level: Application REF: 922-923

OBJ: Special Questions: Alternate Item Format

TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance

17. The nurse receives change-of-shift report about the following four patients. Which patient will the nurse assess first?

a.

A patient who has malnutrition associated with 4+ generalized pitting edema

b.

A patient whose parenteral nutrition has 10 mL of solution left in the infusion bag

c.

A patient whose gastrostomy tube is plugged after crushed medications were given through the tube

d.

A patient who is receiving continuous enteral feedings and has new-onset crackles throughout the lungs

ANS: D

The patient data suggest aspiration has occurred and rapid assessment and intervention are needed. The other patients also should be assessed as quickly as possible, but the data about them do not suggest any immediately life-threatening complications.

DIF: Cognitive Level: Application REF: 932-934

OBJ: Special Questions: Multiple Patients TOP: Nursing Process: Planning

MSC: NCLEX: Safe and Effective Care Environment

18. Which action should the nurse take first in order to improve calorie and protein intake for a patient who eats only about 50% of each meal because of feeling too tired to eat much.

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).

ANS: B

Eating small amounts of food frequently throughout the day is less fatiguing and will improve the patients ability to take in more nutrients. Teaching the patient may be appropriate, but will not address the patients inability to eat more because of fatigue. Tube feedings or PN may be needed if the patient is unable to take in enough nutrients orally, but increasing the oral intake should be attempted first.

DIF: Cognitive Level: Application REF: 929

OBJ: Special Questions: Prioritization TOP: Nursing Process: Planning

MSC: NCLEX: Physiological Integrity

19. The nurse notes that the peripheral parenteral nutrition (PN) bag has only 20 mL left and a new PN bag has not yet arrived from the pharmacy. Which intervention is the priority?

a.

Monitor the patients 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

ANS: C

To prevent hypoglycemia, the nurse should infuse a 5% dextrose solution until the next PN bag can be started. Decreasing the rate of the ordered PN infusion is beyond the nurses scope of practice. Flushing the line and then waiting for the next bag may lead to hypoglycemia. Monitoring the capillary blood glucose is appropriate but is not the priority.

DIF: Cognitive Level: Application REF: 938

OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation

MSC: NCLEX: Physiological Integrity

20. A 22-year-old who is hospitalized with anorexia nervosa is 5 ft 5 in (163 cm) tall and weighs 90 pounds (41 kg). Laboratory tests reveal hypokalemia and iron-deficiency anemia. Which nursing diagnosis has the highest priority for the patient?

a.

Risk for activity intolerance related to anemia and weakness

b.

Risk for electrolyte imbalance related to poor eating patterns

c.

Ineffective health maintenance related to obsession with body image

d.

Imbalanced nutrition: less than body requirements related to refusal to eat

ANS: B

The patients hypokalemia may lead to life-threatening cardiac dysrhythmias. The other diagnoses also are appropriate for this patient but are not associated with immediate risk for fatal complications.

DIF: Cognitive Level: Application REF: 940

OBJ: Special Questions: Prioritization TOP: Nursing Process: Diagnosis

MSC: NCLEX: Physiological Integrity

21. All of the following 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 nursing assistive personnel (NAP)?

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 patients strength while ambulating the patient in the room.

ANS: C

Feeding the patient and assisting with oral intake are included in NAP education and scope of practice. Assessing the patient and assisting the patient in choosing high nutrition foods require LPN/LVN- or RN-level education and scope of practice.

DIF: Cognitive Level: Application REF: 928-929

OBJ: Special Questions: Delegation TOP: Nursing Process: Planning

MSC: NCLEX: Safe and Effective Care Environment

MULTIPLE RESPONSE

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

a.

A 24-year-old who has a history of weight gains and losses

b.

A 53-year-old who complains of intermittent nausea for the past 2 days

c.

A 66-year-old who is admitted for dbridement of an infected surgical wound

d.

A 45-year-old admitted with chest pain and possible myocardial infarction (MI)

e.

A 32-year-old with rheumatoid arthritis who takes prednisone (Deltasone) daily

ANS: A, C, E

Weight fluctuations, use of corticosteroids, and draining or infected wounds all suggest that the patient may be at risk for malnutrition. Patients with chest pain or MI are not usually poorly nourished. Although vomiting that lasts 5 days places a patient at risk, nausea that has persisted for 2 days does not always indicate poor nutritional status or risk for health problems caused by poor nutrition.

DIF: Cognitive Level: Application REF: 924

OBJ: Special Questions: Alternate Item Format, Multiple Patients

TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

COMPLETION

1. While caring for a comatose patient who is receiving continuous enteral nutrition through a soft nasogastric tube, the nurse notes the presence of new crackles in the patients lungs. In which order will the nurse take the following actions? Put a comma and space between each answer choice (a, b, c, d, etc.) ____________________

a. Turn off the tube feeding.

b. Obtain the patients oxygen saturation.

c. Check the tube feeding residual volume.

d. Notify the patients health care provider.

ANS:

A, B, C, D

The assessment data indicate that aspiration may have occurred, and the nurses first action should be to turn off the tube feeding to avoid further aspiration. The next action should be to check the oxygen saturation because this may indicate the need for immediate respiratory suctioning or oxygen administration. The residual volume should be obtained because it provides data about possible causes of aspiration. Finally, the health care provider should be notified and informed of all the assessment data the nurse has just obtained.

DIF: Cognitive Level: Application REF: 931-934

OBJ: Special Questions: Alternate Item Format, Prioritization

TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.

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