SHORT ANSWER
Chapter 40: Nursing Management: Nutritional Problems
Test Bank MULTIPLE CHOICE
1).Which finding for a 19-year-old female who is a vegan may indicate the need for cobalamin supplementation?
Paresthesias
Ecchymoses
Dry, scaly skin
Gingival swelling
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?
Restlessness
Hypertension
Pitting edema
Food allergies
3).Which menu choice indicates that the patient is implementing plans to choose high-calorie, high-protein foods?
Baked fish with applesauce
Beef noodle soup and canned corn
Fresh fruit salad with yogurt topping
Fried chicken with potatoes and gravy
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
iron.
protein.
calories.
carbohydrate.
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?
Slow the infusion rate of the tube feeding.
Check gastric residual volumes more frequently.
Change the enteral feeding system and formula every 8 hours.
Discontinue administration of water through the feeding tube.
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?
Keep the patient positioned on the left side.
Check the gastric residual volume every 4 to 6 hours.
Avoid giving bolus tube feedings through the PEG tube.
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?
Ask the health care provider to clarify the written PN order.
Add a new container of PN using the current tubing and filter.
Hang a new container of PN and change the IV tubing and filter.
Infuse the remaining 50 mL and then hang a new container of PN.
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
obtain a venous blood glucose specimen.
slow the infusion rate of the PN infusion.
recheck the capillary blood glucose in 4 to 6 hours.
notify the health care provider of the glucose level.
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?
Serum albumin level is 3.5 mg/dL.
Fluid intake and output are balanced.
Surgical incision is healing normally.
Blood glucose is less than 110 mg/dL.
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? Order six small meals daily.
Make a referral to the dietitian.
Teach the patient about high-calorie foods.
Have family members bring in favorite foods.
11).When caring for a 63-year-old woman with a soft, silicone nasogastric tube in place for enteral feedings, the nurse will o avoid giving medications through the feeding tube.
o flush the tubing after checking for residual volumes.
administer continuous feedings using an infusion pump.
replace the tube every 3 days to avoid mucosal damage.
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?
Shut the feeding off 30 to 60 minutes before the scan.
Ask the health care provider to reschedule the CT scan.
Connect the feeding tube to continuous suction during the scan.
Send the patient to CT scan with oral suction in case of aspiration.
14).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?
53
66
75
15).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?
The patient uses laxatives daily.
The patient’s knuckles are macerated.
The patient’s serum potassium level is 2.9 mEq/L.
16).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)?
Providing skin care to the area around the tube site
Teaching the patient how to administer tube feedings
Determining the need for adding water to the feedings
Assessing the patient’s nutritional status at least weekly
17).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?
Ask the daughter about the patient’s food preferences.
Determine who shops for groceries and prepares the meals.
Question the patient about how many meals per day are eaten.
Assure the patient that culturally preferred foods will be included.
18).After change-of-shift report, which patient will the nurse assess first?
A 40-year-old woman whose parenteral nutrition infusion bag has 30 minutes of solution left
A 40-year-old man with continuous enteral feedings who has developed pulmonary crackles
A 30-year-old man with 4+ generalized pitting edema and severe protein-calorie malnutrition
A 30-year-old woman whose gastrostomy tube is plugged after crushed medications were administered.
19).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?
Teach the patient about the importance of good nutrition.
Serve multiple small feedings of high-calorie, high-protein foods.
Obtain an order for enteral feedings of liquid nutritional supplements.
Consult with the health care provider about providing parenteral nutrition (PN).
20).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?
Monitor the patient’s capillary blood glucose until a new PN bag is hung.
Flush the peripheral line with saline and wait until the new PN bag is available.
Infuse 5% dextrose in water until the new PN bag is delivered from the pharmacy.
Decrease the rate of the current PN infusion to 10 mL/hr until the new bag arrives.
21).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?
Risk for activity intolerance related to anemia
Risk for electrolyte imbalance related to eating patterns
Ineffective health maintenance related to body image obsession
Imbalanced nutrition: less than body requirements related to anorexia
22).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)?
Assist the patient to choose high-nutrition items from the menu.
Monitor the patient for skin breakdown over the bony prominences.
Offer the patient the prescribed nutritional supplement between meals.
23).A severely malnourished patient reports that he is Jewish. The nurse’s initial action to meet his nutritional needs will be to o have family members bring in food.
o ask the patient about food preferences.
teach the patient about nutritious Kosher foods.
order nutrition supplements that are manufactured Kosher.
MULTIPLE RESPONSE
1).Which of the nurse’s assigned patients should be referred to the dietitian for a complete nutritional assessment ( select all
that apply)?
A 23-year-old who has a history of fluctuating weight gains and losses
A 35-year-old who complains of intermittent nausea for the past 2 days
A 64-year-old who is admitted for débridement of an infected surgical wound
A 52-year-old admitted with chest pain and possible myocardial infarction (MI)
A 48-year-old with rheumatoid arthritis who takes prednisone (Deltasone) daily
OTHER
1).The nurse is caring for a 47-year-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].)
Check the patient’s oxygen saturation.
Notify the patient’s health care provider.
Measure the tube feeding residual volume.