Nutritional support 7

A client receiving total parenteral nutrition for 3 days becomes disoriented and removes her intravenous line. A new line cannot be inserted for 2 to 3 hours. The nurse should monitor the client for: a. hypoglycemia. b. infection. c. air embolism. d. hyperglycemia.

ANS: A Abruptly discontinuing TPN can lead to hypoglycemia.

A nurse is evaluating a client for commencement of enteral feedings. The most appropriate client to receive enteral feeding is the client who has _____ bowel sounds. a. decreased b. absent c. intact d. occasional .

ANS: A Absent or decreased bowel sounds indicate a lack of peristalsis. This is an important nursing assessment before initiating feedings

The client most likely to be treated with total parenteral nutrition (TPN) is the client who has: a. gastrointestinal (GI) dysfunction. b. inadequate nutritional intake. c. an intact gastrointestinal system. d. a decreased immune system.

ANS: A TPN is indicated for the client who has gastrointestinal dysfunction.

client has a large episode of diarrhea during an enteral feeding. What should be the first nursing action? a. Slow the feeding. b. Stop the feeding. c. Call the physician. d. Administer an antidiarrheal agent.

ANS: A The most common cause of diarrhea during a feeding is dumping syndrome as a result of rapid feed infusion. Slowing the feeding is the appropriate initial action.

A nurse received a client from the PACU after a major bowel resection. The client was started on total parenteral nutrition with 40% glucose in the PACU. In the report, the PACU nurse instructs that the patient must be monitored for hyperglycemia. What are the manifestations of hyperglycemia? (Select all that apply.) a. Increased urine output b. Headache c. Dry mucous membranes d. Diaphoresis e. Lethargy f. Glycosuria g. Thirst

ANS: A, C, E, F, G These are the signs of hyperglycemia. The other options are typically noted with hypoglycemia.

A client is receiving total parenteral nutrition (TPN). The nurse assesses for which potential complications of TPN? (Select all that apply.) a. Hyperglycemia b. Diarrhea c. Hypervolemia d. Immunosuppression e. Infection f. Aspiration g. Air embolism h. Hypoglycemia

ANS: A, C, E, G, H These are potential complications. TPN does not place a client at risk for diarrhea, immunosuppression, or aspiration.

A nurse has checked the residual in a gastrostomy tube before providing a feeding for an adult client. The previous feeding of 240 mL was given 4 hours ago. The residual was 75 mL. What should the nurse do? a. Administer the feeding as ordered. b. Stop the infusion, wait 1 hour, and check the residual again. c. Hold the feeding and call the physician for orders. d. Administer half of the ordered feeding and then check residual.

ANS: B If residual is more than 50 mL, stop infusion for 30 minutes to 1 hour, and then recheck.

The physician orders nutrient support for a client with a traumatic injury. The nurse recognizes the purpose of this order, which is to: a. improve cardiac function. b. enhance wound healing. c. improve intestinal and liver blood flow. d. improve general health.

ANS: B Positive nitrogen balance and protein intake are associated with wound healing.

A client has been ordered to be treated with total parenteral nutrition (TPN). For which complications will the nurse monitor the client most closely? a. Pulmonary embolism b. Air embolism c. Nausea and vomiting d. Ascites

ANS: B TPN with IV therapy is prone to air embolism.

The client is being treated with total parenteral nutrition. The nurse is monitoring the client closely for evidence of infection during the first week of treatment. The nurse recognizes that the dressing over the catheter insertion site should be changed every _____ hours. a. 48 b. 24 c. 16 d. 8

ANS: B The client being treated with TPN should have the dressing over his catheter changed every 24 hours for the first 10 days.

The nurse instructs the client to prevent air embolism with total parenteral nutrition (TPN) by performing the Valsalva's maneuver. The nurse instruct the client to take a breath, then: a. breathe rapidly. b. hold it, and bear down. c. exhale and bear down. d. exhale and hold it.

ANS: B Valsalva's maneuver is performed by taking a breath, holding it, and bearing down.

The client is being treated with enteral feeding. Before administering the feeding, the nurse plans to elevate the head of the client's bed _____ degrees. a. 90 b. 45 c. 30 d. 15

ANS: C Before administering an enteral feeding, the nurse should elevate the head of the client's bed 30 degrees.

Water is an essential component in enteral feedings for the client because it: a. keeps the solution intact. b. increases the solution volume. c. maintains hydration state. d. decreases the thickness of the solution.

ANS: C Dehydration is a common side effect of enteral feeding; free water must be given to avoid dehydration.

A client is to receive amoxicillin (Amoxil, Augmentin) suspension. The nurse recognizes which complication of the medication that is due to its hyperosmolar state? a. Vomiting b. Severe headaches c. Diarrhea d. Clotting abnormalities

ANS: C Liquid medications are usually hyperosmolar and therefore may produce diarrhea.

A nutritionist is working with a family discussing nutritional options for a client in a comatose state. Which statement is true of enteral feedings but not true of parenteral feedings? a. They are more expensive. b. They have a higher infection rate. c. They pose a greater risk of aspiration. d. They can be used with intestinal obstruction.

ANS: C Parenteral nutrition is more expensive, has a higher infection rate, and can be used with intestinal obstruction. Aspiration is the only option characteristic of enteral feedings.

A client begins total parenteral nutrition to enhance nutritional status before surgery. The nurse is providing teaching about this treatment. Which statement by the client indicates a need for more teaching? a. "The TPN fluid is a complete nutritional solution." b. "I will urinate a lot because of the fluid and the sugar." c. "I can take the IV dressing off in the shower." d. "I need my urine and blood checked frequently."

ANS: C The IV dressing is sterile and must stay in place.

A client is receiving 300 mL of Isocal every 4 hours by intermittent enteral feedings. What is the optimal method to receive the enteral feeding with this volume? a. Direct use of a syringe or funnel b. Infusion pump over 24 hours c. Gravity drip or infusion pump over 30 to 60 minutes d. Gravity drip or infusion pump over 8 to 16 hours

ANS: C The other options listed pertain to types of feedings other than enteral.

The most likely candidate for total parenteral nutrition is the client: a. with a low risk of aspiration. b. with a well-functioning GI tract. c. without intravenous access. d. diagnosed with malnutrition and cancer.

ANS: D Clients with malnutrition, cancer, and other conditions are best served with parenteral therapy.

A client is recovering from a cerebrovascular accident (stroke) and is receiving gastrostomy tube feedings. He is placed on aspiration precautions. What independent nursing action can the nurse implement? a. Thicken the feedings with cereal. b. Warm the formula. c. Advance the feeding tube into the duodenum. d. Elevate the head of the bed.

ANS: D Elevating the head of the bed is the initial intervention when a client is on aspiration precautions.

A client is receiving total parenteral nutrition (TPN) via a central line. Which condition predisposes this client to infection? a. High protein content in the TPN b. WBC count of 7800/mm c. Line being in a small IV line d. Glucose content of the solution

ANS: D Glucose creates a medium for bacterial growth.

What is a complication of total parenteral nutrition (TPN) not found with enteral feelings? a. Dehydration b. Aspiration if supine c. Frequent diarrhea d. Pneumothorax

ANS: D TPN is administered intravenously. Enteral feedings have increased risk of the other three contraindications.

The client is being treated with total parenteral nutrition. She is experiencing cough, dyspnea, neck vein engorgement, chest rales, and weight gain. These symptoms most likely are the result of: a. pneumothorax. b. air embolism. c. infection. d. fluid overload.

ANS: D The client being treated with TPN who is also experiencing cough, dyspnea, neck vein engorgement, chest rales, and weight gain is most likely to be experiencing fluid overload.

The client is being treated with total parenteral nutrition. He is experiencing sharp chest pain and decreased breath sounds. These symptoms most likely are the result of: a. fluid overload. b. infection. c. air embolism. d. pneumothorax.

ANS: D The client being treated with TPN who is also experiencing sharp chest pain and decreased breath sounds is most likely to be experiencing pneumothorax

Liquid medications should be diluted to reduce the osmolality of the drug to 500 mOsm. The client is to receive amoxicillin (Amoxil, Augmentin) 250 mg, qid. The medication is available as 50 mg/mL. The osmolality of amoxicillin is 2250 mOsm. How many milliliters of total liquid and medication should the client receive? a. 5 mL b. 10 mL c. 17.5 mL d. 22.5 mL

ANS: D To calculate the volume, the following formula should be used: (2250 mOsm ÷ 500 mOsm) ´ 5 mL = 22.5 mL.