Pharm II Week 2 Enteral and Parenteral Nutrition/Electrolyte Balance
John Adams is a 26-year-old male client who was brought to your emergency room following a motor vehicle accident that fractured his left femur. He is pale and in obvious pain. His vital signs are heart rate of 144 beats/min, blood pressure 90/45, and respiratory rate 28 breaths/min. What do you expect to administer?
2 units packed RBCs over 2 hours each Mr. Adams's vital signs indicate blood loss from a traumatic injury. The most appropriate replacement fluid is packed red blood cells (RBCs) administered over 2-4 hours, as tolerated. Although normal saline is an isotonic fluid and will temporarily increase volume, the blood loss should be replaced with packed RBCs. D5-LR is a hypertonic solution and is usually prescribed to replace sodium loss. Plasma-Lyte 56 is a hypotonic solution administered to a dehydrated client. However, it would not be the best solution to administer to a trauma client with a known acute blood loss.
An older male client is at risk for developing a fluid deficit because he is unaware of the causes of dehydration. When teaching the client about dehydration, which causes would the nurse include? Nausea leading to vomiting, and diarrhea Loss of a large amount of blood Abuse of diuretics Hormone therapy Profuse sweating
A) Nausea leading to vomiting, and diarrhea B) Abuse of diuretics D) Profuse sweating E) Loss of a large amount of blood Excessive vomiting with nausea and diarrhea can cause dehydration, especially in children and older adults. Excessive or profuse sweating can cause dehydration. Hemorrhage and profuse bleeding can cause dehydration. The use and abuse of diuretics can cause a client to become dehydrated if fluid intake is not properly managed. Proper administration of hormone therapy should not cause dehydration.
The nurse is caring for a client who is receiving enteral nutrition through a feeding tube, and is experiencing diarrhea. What actions should the nurse take? Add fiber to the nutritional supplement. Administer loperamide (Imodium), an antidiarrheal, as ordered. Test for Clostridium difficile. Increase the concentration of the feeding. Increase the infusion rate.
Add fiber to the nutritional supplement. Administer loperamide (Imodium), an antidiarrheal, as ordered. Test for Clostridium difficile. If a client experiences diarrhea during enteral therapy through a feeding tube, the nurse should: Test for Clostridium difficile, because the stool could have bacterial overgrowth that is causing the diarrhea Administer an antidiarrheal as ordered by the healthcare provider. Add fiber to the nutritional supplement.bullet Decrease the infusion rate. Dilute the feeding.
Which are appropriate nursing actions for the client receiving enteral feeding who has the complication of diarrhea? Select all that apply.
Add fiber to the nutritional supplement. Dilute the feeding. Slow down the infusion. Appropriate nursing actions for the client with diarrhea related to enteral feedings include slowing the infusion, adding fiber to the nutritional supplement, and diluting the feeding. Decreasing the use of opioids and changing the formula to a low-fat preparation are appropriate nursing actions for the client with nausea and vomiting.
Maxine Carlson is a 73-year-old woman who was admitted to the hospital after suffering a cerebrovascular accident. Her deficits include right-side paralysis, inability to swallow, and global aphasia. Mrs. Carlson has a nasogastric tube inserted and begins bolus enteral feedings, 300 mL every 6 hours. What is a significant risk associated with bolus feedings?
Aspiration One of the complications associated with bolus feedings is the risk for aspiration. Hyperglycemia and hypoproteinemia can be associated with enteral feedings. However, they relate more to the type of nutritional supplement than to the method of feeding. Diarrhea, not constipation, is associated with bolus feedings.
The nurse is caring for an older adult client who is diagnosed with inflammatory bowel disease, and receiving enteral nutrition therapy to rest the bowel. The nurse should watch for which complications of enteral nutrition? Select all that apply. Aspiration Subcutaneous emphysema Thromboembolism Nausea Dehydration
Aspiration Nausea Dehydration Complications of enteral nutrition include aspiration, nausea, vomiting, diarrhea, metabolic complications (dehydration, electrolyte disturbances, and hyperglycemia), interrupted infusion, and food-drug interactions. Thromboembolism and subcutaneous emphysema are possible complications of parenteral, not enteral, nutrition.
The nurse is taking care of an adult client in the emergency department who was in a motor vehicle crash and is bleeding profusely. Which intravenous fluids will be administered to the client to regulate the body fluid imbalance caused by the profuse bleeding? Oral fluids Hypotonic fluids Blood products Hypertonic fluids
Blood products A client with profuse bleeding would receive blood products, given intravenously, to correct body fluid imbalance. Hypertonic fluids are best for clients requiring sodium replacement therapy. Hypotonic fluid therapy is given to a client who is dehydrated. Oral fluids are administered to clients who are dehydrated and can drink more fluids.
After the blood has infused for 15 minutes, Mr. Adams complains of chills and a headache. His oral temperature is 101.6°F (38.7°C). What is the most likely cause of his clinical manifestations?
Blood transfusion reaction The most likely cause of Mr. Adams's clinical manifestations is a transfusion reaction. Common clinical manifestations associated with a transfusion reaction include fever, chills, headache, dizziness, dyspnea, and hypotension. Anxiety does not usually contribute to a fever and chills. Pain may result in tachycardia and hypotension, but it does not normally cause a fever and chills. Although a reaction to pain medication may cause a slight elevation in temperature, it is not likely to cause all three clinical manifestations. In addition, information concerning pain medication was not included with this question.
Which types of nutrients are administered to provide energy for the body and to maintain normal glucose levels?
Carbohydrates Carbohydrates are administered to provide energy for the body and maintain normal glucose levels. Proteins are administered to maintain cell growth and assist with tissue healing. Lipids are administered to provide energy for the body. Vitamins and minerals are other supplements that aid in tissue repair and overall cellular function.
What type of ion is released by the lungs to help maintain the correct pH level in the body? Phosphate Carbon dioxide Bicarbonate Hydrogen
Carbon dioxide Carbon dioxide is an acid ion released by the lungs during exhalation. Hydrogen ions are acid ions released by the kidneys in the urine. Bicarbonate and phosphate ions are part of the buffer system within the body that help maintain an optimal pH level by neutralizing acids and bases.
What is the most important adverse reaction to monitor for when administering intravenous potassium? Cardiac dysrhythmia Pain at the insertion site Confusion Nausea
Cardiac dysrhythmia The most important nursing action during the administration of potassium chloride is to monitor the client for cardiac dysrhythmias. Although pain at the insertion site and GI symptoms (such as diarrhea, nausea, and vomiting) can occur with a potassium infusion, the development of cardiac dysrhythmia is the most critical of these potential reactions. Confusion may be seen during the administration of either magnesium sulfate or high concentrations of sodium chloride.
What complications are associated with fluid volume replacement? Select all that apply. Nausea Cardiovascular stress Dyspnea Fluid in the lungs Fever and chills
Cardiovascular stress Dyspnea Fluid in the lungs Clinical manifestations associated with fluid volume replacement include fluid overload (caused by excess water and sodium intake), fluid in the lungs, dyspnea, and cardiovascular stress. Nausea, fever, and chills are clinical manifestations associated specifically with a blood transfusion reaction and would not be seen with fluid volume replacement.
Which are mechanical complications associated with parenteral nutrition? Select all that apply.
Catheter malposition Cardiac arrhythmias Hemothorax Mechanical complications associated with a central venous line include hemothorax, catheter malposition, and cardiac arrhythmias. Fluid volume overload is a metabolic complication. Infections are associated with peripheral line parenteral nutrition; however, they would not be considered a mechanical complication.
The nurse is caring for an older adult client who is receiving total parenteral nutrition (TPN). What should the nurse assess to minimize complications? Catheter placement Feeding tube placement Intake and output Weight and lab results Vital signs
Catheter placement Intake and output Weight and lab results Vital signs To minimize complications in a client receiving TPN, the nurse should assess intake and output, vital signs, weight, lab results, and catheter placement. A client receiving TPN does not have a feeding tube to assess.
The nurse is assessing a client with alkalosis who is being treated with acid agents. What adverse effects might the nurse observe when treating this client with ammonium chloride? Nausea and vomiting Yellow skin color Decreased respiratory rate Central nervous system depression
Central nervous system depression The most severe adverse effect that the nurse might observe when treating a client's alkalosis with an acid agent would be central nervous system depression. Yellow skin color, or jaundice, is not an adverse effect of treatment with ammonium chloride. Decreased respiratory rate, nausea, and vomiting are possible adverse effects of sodium bicarbonate, not ammonium chloride, administration.
The nurse is caring for a client who is receiving enteral therapy through a gastrostomy tube. Which interventions by the nurse will reduce the risk of aspiration? Check for signs of respiratory distress, abnormal lung sounds, or frothy sputum. Elevate the head of the bed 30 degrees during feeding. Check for gastric residual volumes. Reduce the rate of administration. Check for proper tube placement.
Check for signs of respiratory distress, abnormal lung sounds, or frothy sputum. Elevate the head of the bed 30 degrees during feeding. Check for gastric residual volumes. Check for proper tube placement. Elevating the head of the bed at least 30 degrees for the feeding, and for at least 30 min thereafter; checking for proper tube placement; and checking for residual volumes before each bolus feeding and every 4-6 hours during continuous feedings helps to reduce the risk of aspiration. Reducing the rate of administration can help decrease nausea, vomiting, and diarrhea, but does not prevent aspiration.
The nurse is educating an adult client on the causes of metabolic acidosis. Which causes would the nurse include in the client education? Chronic renal failure Potassium-wasting diuretics Diabetes mellitus Tissue hypoxia Acute diarrhea
Chronic renal failure Diabetes mellitus Tissue hypoxia Acute diarrhea Diabetes mellitus can develop into diabetic ketoacidosis. Tissue hypoxia can alter electrolytes and cause metabolic acidosis. Chronic renal failure can lead to metabolic acidosis. Acute diarrhea alters the acid-base balance in the body and can cause metabolic acidosis. The use of potassium-wasting diuretics may cause metabolic alkalosis, not acidosis.
Enteral feedings delivered over an 8- to 16-hour period of time are called:
Cyclic feedings Cyclic feedings are delivered over an 8- to 16-hour time period. In bolus feedings, clients receive a large volume of solution every 4dash6 hours as ordered. Intermittent feedings take about 30dash60 minutes to deliver. Continuous infusion feedings are administered through an infusion pump over a 16- to 24-hour period.
Prior to administering fluid replacement therapy, the nurse is assessing a child for signs of dehydration. Which signs and symptoms indicate that the child is dehydrated and may need IV fluids? Decreased urine output Increase in weight Increased urine specific gravity Dry mouth and mucous membranes Poor skin turgor
Decreased urine output Increased urine specific gravity Dry mouth and mucous membranes Poor skin turgor Signs of dehydration include poor skin turgor with a decrease in elasticity, a decrease in urine output, an increase in urine specific gravity, and a dry mouth and mucous membranes. All of these signs in a child indicate that the child may need IV fluids. Weight loss, not weight gain, might indicate dehydration.
The nurse is assessing an older adult client with a history of progressive dysphagia who is receiving enteral nutrition through a nasogastric tube. The nurse should observe for which metabolic complication? Thromboembolism Subcutaneous emphysema Dehydration Pneumothorax
Dehydration Complications of enteral nutrition therapy include aspiration, nausea, vomiting, diarrhea, and metabolic complications (dehydration, electrolyte disturbances, and hyperglycemia). Pneumothorax, thromboembolism, and subcutaneous emphysema are possible complications of parenteral nutrition therapy.
The nurse is caring for a teenage client who has been diagnosed with anorexia nervosa. The nurse should be concerned with which potential complications of malnutrition? Select all that apply. Group of answer choices Excessive muscle bulk Delayed wound healing Muscle wasting Insufficient immunity Death
Delayed wound healing Muscle wasting Insufficient immunity Death Anorexia nervosa is an eating disorder that leads to protein deficiency and weight loss (malnutrition). Protein deficiency, in turn, leads to several symptoms and complications, including delayed wound healing. Other complications include wasting away of muscle, insufficient immunity to protect against infection, and death.
While administering magnesium sulfate to Mr. Stevens, for which clinical manifestations of magnesium toxicity do you need to watch?
Depressed tendon reflexes Toxicity associated with magnesium sulfate administration (hypermagnesemia) includes CNS depression and depressed deep tendon reflexes. Seizures, muscle twitching, and nausea and vomiting are clinical manifestations associated with hypomagnesemia and would not indicate toxicity.
The nurse is admitting a new client with a medical diagnosis of fluid volume deficit, or dehydration. The client asks the nurse what causes dehydration. What does the nurse teach the client about the factors and conditions that can lead to fluid volume deficit (dehydration)? Eating contaminated food that causes severe nausea with vomiting and diarrhea Dysphagia secondary to a stroke (cerebral vascular accident) Taking prescribed "water pills" (diuretics) to control hypertension (high blood pressure) Having dry mouth, orthostatic hypotension, and decreased skin turgor, capillary refill, and urine output Exercising outdoors during very hot weather conditions
Eating contaminated food that causes severe nausea with vomiting and diarrhea Dysphagia secondary to a stroke (cerebral vascular accident) Taking prescribed "water pills" (diuretics) to control hypertension (high blood pressure) Exercising outdoors during very hot weather conditions Exercising outdoors during very hot weather conditions Food poisoning often occurs when food or water that is contaminated with certain types of bacteria, parasites, viruses, or toxins has been consumed; most cases of food poisoning are due to common bacteria such as Staphylococcus sp. or Escherichia coli (E. coli). An individual can develop a fluid volume deficit from excessive loss of gastrointestinal fluids through excessive vomiting and diarrhea as a result of food poisoning. Exercising in warm or high temperatures can cause dehydration; both the exercise and the air temperature increase the body's core temperature, which can easily lead to excess fluid loss and dehydration. "Water pills," or diuretics, are medicines that stimulate the body's excretion of fluid and electrolytes. Diuretics work by making the kidneys excrete more sodium into the urine, which then increases the amount of water flowing out of the body; overuse or inappropriate use can thus cause dehydration. A swallowing disorder, also called dysphagia, occurs in up to 65% of those who experience a stroke. If not identified and managed, swallowing problems (dysphagia) can lead to poor nutrition and dehydration. Decreased skin turgor, capillary refill, and urine output; dry mouth; and orthostatic hypotension are signs and symptoms, not causes, of fluid volume deficit.
What is a critical nursing action to prevent aspiration when administering enteral feedings?
Elevate the head of the bed 30 degrees. To decrease the risk of aspiration when administering enteral feedings, elevate the head of the bed at least 30 degrees during the entire tube feeding, and for at least 30 minutes afterward. Metoclopramide (Reglan) is administered to decrease nausea and vomiting. The feeding may be diluted for the client with diarrhea. Refeeding syndrome is a major complication of enteral feedings that includes dehydration, hyperglycemia, and electrolyte disturbances.
The nurse reviews a client's diagnostic test results. Which lab values indicate that the client is experiencing a fluid volume deficit, or dehydration? Elevated hematocrit and serum osmolality Increased central venous pressure and decreased serum sodium level Increased serum sodium and elevated hematocrit level Increased urine specific gravity and serum osmolality Decreased serum sodium and hematocrit level
Elevated hematocrit and serum osmolality Increased serum sodium and elevated hematocrit level Increased urine specific gravity and serum osmolality The results of several diagnostic tests will help determine if a client is experiencing fluid volume deficit. Elevated serum sodium, serum osmolality, hematocrit, hemoglobin, and urine specific gravity, especially if combined with decreased central venous pressure, indicate that a client is experiencing fluid volume deficit.
An older adult client undergoing cancer chemotherapy is receiving total parenteral nutrition (TPN) through a central line. The nurse knows that the client is at risk for which mechanical complications? Fluid volume overload Bone demineralization Endocarditis Hemothorax Brachial plexus injury
Endocarditis Hemothorax Brachial plexus injury Mechanical complications of TPN administration include pneumothorax, brachial plexus injury, endocarditis, subcutaneous emphysema, and venous thrombosis. Fluid volume overload and bone demineralization are metabolic, not mechanical, complications of TPN administration.
Jennifer Sanchez is a 24-year-old female who presents to your clinic after four days of worsening nausea, vomiting, and diarrhea. She states that she has tried to drink fluids but cannot keep anything down. Her heart rate is 126 beats/min, blood pressure 118/70 lying down and 86/50 sitting, and temperature 99.8°F (37.7°C). What is Ms. Sanchez most likely experiencing?
Fluid volume deficit Ms. Sanchez is most likely suffering from fluid volume deficit caused by a loss of gastrointestinal (GI) fluids from vomiting and diarrhea. Clinical manifestations related to fluid volume deficit include tachycardia and orthostatic hypotension. Although tachycardia may be associated with anxiety, orthostatic hypotension is not. Although thirst may accompany fluid volume deficit, there is no indication that Ms. Sanchez is experiencing excessive thirst. Hypernatremia may occur in a dehydrated client, but this is not indicated by the information provided.
The nurse is administering pharmacotherapy to a client with severe hyperkalemia. Which agent helps the body to eliminate potassium through urination? Furosemide (Lasix) Polystyrene sulfonate (Kayexalate) Insulin with dextrose Calcium gluconate
Furosemide (Lasix) Furosemide (Lasix) is a diuretic that reduces potassium levels through urination. Insulin with dextrose administered intravenously will cause potassium to enter the cells and reduce serum potassium levels, but it does not eliminate potassium through urination. Calcium gluconate is given to prevent cardiac complications when serum potassium levels are too high. Polystyrene sulfonate (Kayexalate) decreases potassium levels by eliminating potassium through the intestinal route, not through urination.
The nurse is assessing an adult client with fluid loss from diarrhea and vomiting. Which tests would indicate that the client is actually dehydrated? Hemoglobin and hematocrit Urine specific gravity Serum electrolytes Serum osmolality Chest x-ray
Hemoglobin and hematocrit Urine specific gravity Serum electrolytes Serum osmolality When a client is dehydrated, the serum electrolytes would show an elevated sodium level. Serum osmolality, hemoglobin, hematocrit, and urine specific gravity would be increased with dehydration. A chest x-ray may be part of a diagnostic work-up, but would not indicate that a client is dehydrated.
The nurse is reviewing a client's electrolyte panel. Which statements about sodium are true? Normal sodium levels range from 145-165 mEq/L. High sodium levels can cause weakness. The kidneys regulate sodium levels. Hypernatremia can cause anorexia. To replace sodium in the body, drink more water.
High sodium levels can cause weakness. The kidneys regulate sodium levels. The kidneys regulate fluid balance and sodium levels. One of the symptoms of hypernatremia is weakness. Hyponatremia, not hypernatremia, can cause anorexia, nausea, vomiting, and abdominal cramping. Normal sodium levels for adults range from 135-145 mEq/L, not 145-165 mEq/L. Sodium and water work together in the body. Sodium within the body can be maintained through a regular daily diet. Drinking water alone will not replace sodium within the body.
Robert Stevens, a 46-year-old male client, presents to your emergency room with progressive chest pain diagnosed as a lateral-wall myocardial infarction. Mr. Stevens has a history of hypertension treated with a calcium channel blocker. He states that he consumes 3-4 glasses of whiskey every evening. What electrolyte imbalance would likely be treated in the presence of a myocardial infarction?
Hypomagnesemia Magnesium is an active cardiovascular electrolyte. Thus, symptoms of hypomagnesemia may include cardiac complications such as dysrhythmias. Clients with a myocardial infarction are often treated for hypomagnesemia to improve their cardiac conduction. Chronic alcoholics also often develop hypomagnesemia. Although hypokalemia may be a concern in a client with a dysrhythmia, there is no indication that Mr. Stevens is at risk for this imbalance. There are no predisposing factors that would contribute to hyponatremia or hypernatremia in this client.
Eva Gonzales is a 35-year-old woman who is admitted for nutritional evaluation. She had a bilateral mastectomy 3 months prior to this hospital admission. Ms. Gonzales recently completed a combination treatment regimen of radiotherapy and chemotherapy. Her caregivers are concerned about her depression and suppressed immune status. What must you determine before selecting the form of supplemental nutrition for Ms. Gonzales?
If she has any mechanical problems that will prevent the administration of enteral nutrition Before determining the form of supplemental nutrition, you must identify any mechanical problems or other restrictions that would prevent the administration of enteral nutrition. Factors such as nothing by mouth, diagnosis, recent weight loss, usual dietary habits, serum albumin level, and financial status should all be considered. Infection is not a contraindication for either enteral or parenteral nutrition. Although a medication history is important, the client's medications would not be factors in determining the type of supplemental nutrition. The client's cooperation is desirable, but not essential, when providing supplemental nutrition.
Which condition does the nurse know is an indication for enteral nutrition therapy? Inadequate oral intake Intractable vomiting Complete bowel obstruction Inability to absorb nutrients
Inadequate oral intake Inadequate oral intake is an indication for enteral nutritional therapy. Intractable vomiting, inability to absorb nutrients via the gastrointestinal (GI) tract, and complete bowel obstruction are not indications for enteral nutritional therapy.
David Flores, a 68-year-old carpenter, has a long history of irritable bowel syndrome and ulcerative colitis. He was recently admitted to the hospital with a severe exacerbation of his colitis that required parenteral nutrition therapy. Initially, a peripheral intravenous line was used until a central venous catheter was placed later. What is a risk associated with administering parenteral nutrition through the peripheral intravenous route?
Infection and phlebitis Total parenteral nutrition (TPN) is administered intravenously through either a peripheral vein or a central vein. Risks associated with peripheral vein administration of TPN include infection and phlebitis. Pneumothorax, cardiac arrhythmias, and puncture of the subclavian artery are complications associated with central line placement and central vein administration of TPN.
Which agents are used to treat severe hyperkalemia? Select all that apply. Potassium chloride Insulin with glucose Magnesium citrate (Citrate of Magnesia) Sodium polystyrene sulfonate (Kayexalate) Furosemide (Lasix)
Insulin with glucose Sodium polystyrene sulfonate (Kayexalate) Furosemide (Lasix) Treatment for severe hyperkalemia (elevated potassium) may include furosemide (Lasix), a diuretic that reduces potassium; insulin with glucose or dextrose, which causes potassium to enter the cells; calcium gluconate or calcium chloride, which decrease cardiac complications; sodium bicarbonate, which corrects acidosis; or sodium polystyrene sulfonate (Kayexalate), which binds with potassium in the intestinal tract for elimination. Administering potassium chloride would make the hyperkalemia worse. Magnesium citrate (Citrate of Magnesia) is given to clients who have hypomagnesemia, not hyperkalemia.
Where is two-thirds of the body's total fluid located? Interstitial space Extracellular space Intracellular space Intravascular space
Intracellular space About two-thirds of total body fluid is found in the intracellular space, located within the cells. About one-third of total body fluid is located in the extracellular space outside the cells. The intravascular and interstitial spaces are part of the extracellular space.
Based on Ms. Sanchez's condition, what order do you expect to receive from the healthcare provider?
Intravenous fluids Intravenous isotonic fluids are administered to restore fluid balance in a client with dehydration. Ms. Sanchez probably has very little urine in her bladder because of her lack of fluid intake. Inserting an indwelling catheter would only confirm that little urine is present; it would not address Ms. Sanchez's dehydration. Ms. Sanchez is not tolerating oral intake and therefore a clear liquid diet would not be warranted until her symptoms resolve. A 3% sodium bolus is a hypertonic solution that would contribute further to her intravascular dehydration.
Which clinical manifestations are associated with acidosis? Select all that apply. Slow, shallow breathing Kussmaul breathing Lethargy Cardiac arrest Hyperactive reflexes
Kussmaul breathing Lethargy Cardiac arrest Clinical manifestations associated with acidosis include lethargy, confusion, CNS depression, coma, weakness, fatigue, cardiac dysrhythmias, cardiac arrest, and Kussmaul breathing (deep and rapid respirations). Slow, shallow breathing and hyperactive reflexes are adverse effects associated with alkalosis.
The nurse is caring for an adult client with hypomagnesemia. Which factors does the nurse recognize as causes of this disorder? Laxative abuse Magnesium supplements Loop diuretic therapy Diarrhea and vomiting Kidney failure
Laxative abuse Loop diuretic therapy Diarrhea and vomiting Kidney failure Hypomagnesemia is decreased serum magnesium. In kidney failure, electrolytes, including magnesium, are not maintained properly. Loop diuretic therapy may cause too much magnesium to be excreted. Diarrhea and vomiting cause dehydration and low levels of electrolytes, including magnesium. Laxative abuse can cause electrolyte imbalances and low levels of magnesium. Taking a magnesium supplement may lead to too much magnesium in the body, not too little.
Which conditions may require the infusion of a colloid? Select all that apply. Liver failure Pulmonary edema Myocardial infarction Shock Neonatal hemolytic disease
Liver failure Shock Neonatal hemolytic disease Colloids are administered to increase plasma volume. Conditions that warrant the administration of a colloid agent include severe burns, shock,hemorrhage, liver failure, and neonatal hemolytic disease. Fluid administration is often restricted in clients with a myocardial infarction and pulmonary edema, to decrease the workload of the heart.
Which health-related issues may require administration of supplemental nutrition? Select all that apply.
Malnutrition Major trauma Bulimia Weakened immune status Supplemental nutrition may be required by clients with health-related issues such as eating disorders (anorexia or bulimia), weakened immune states caused by HIV/AIDS or chemotherapy, malnutrition, and major injury or trauma. Although a client with pneumonia may require nutritional supplements, the pneumonia is not a specific health-related issue associated with a need for supplemental nutrition.
Angela Degrasso is a 34-year-old noncompliant type 1 diabetic female. She presents to your emergency room with a glucose level of 450 (normal range is 80-120), lethargy, and a respiratory rate of 32 breaths/min. Laboratory analysis reveals a serum pH level of 7.28. Based on her history and this lab result, what is the most likely cause of her symptoms?
Metabolic acidosis The body's normal pH is 7.35-7.45. A pH of 7.28 represents an acidotic condition. Diabetic ketoacidosis is a common cause of metabolic acidosis and the contributing cause in this case. Although a respiratory rate of 32 may often indicate respiratory alkalosis, Ms. Degrasso's pH lab result confirms an acidotic condition. Both respiratory alkalosis and metabolic alkalosis are associated with a pH level greater than 7.45.
What body functions do electrolytes affect? Select all that apply. Hunger Muscle function Neurologic activity Water balance Bone formation
Muscle function Neurologic activity Water balance Bone formation Maintaining a balance of electrolytes is essential to the body's homeostasis. Electrolytes affect multiple functions in the body, including muscle function, neurologic activity, water balance, and bone formation. Although anorexia and changes in appetite are often clinical manifestations associated with electrolyte imbalances, electrolytes do not directly affect hunger.
Which are serious health consequences that can result from lack of proper nutrients? Select all that apply.
Muscle wasting Decreased wound healing Risk for infection Lack of proper nutrients (amino acids, vitamins, minerals, fats, and carbohydrates) can lead to many serious health consequences, including nonhealing or slow healing of wounds, risk for infection, and wasting away of muscle. Nausea, vomiting, and diarrhea are not serious health consequences caused by lack of proper nutrients.
Which complications can occur during the administration of enteral nutrition? Select all that apply.
Nausea and vomiting Drug and food interactions Clogged feeding tubes Aspiration Many complications can occur during the administration of enteral nutrition, including aspiration, nausea and vomiting, clogged feeding tubes, and drug and food interactions. Muscle wasting is associated with malnutrition rather than enteral feedings.
The nurse is assessing a child with mild dehydration secondary to diarrhea. In a nonacute situation, what is the preferred way to replace electrolytes whenever possible? IV plasma expanders Oral hydration Blood product infusion IV fluids
Oral hydration To treat mild electrolyte imbalances from dehydration in a nonacute situation, the preferred way to rehydrate the client is by oral fluid intake. IV fluids are a last-resort method to replace electrolytes. Blood products are given for blood loss, not for simple dehydration or electrolyte imbalance. Plasma expanders are not used for simple dehydration, although they are used for large amounts of fluid loss or blood loss.
The nurse is caring for a client with swallowing difficulties who is expected to require enteral nutrition for 6-8 weeks. What type of tube would the nurse expect to be used for this client? Nasogastric tube Percutaneous endoscopic gastrostomy tube Nasoduodenal tube Nasojejunal tube
Percutaneous endoscopic gastrostomy tube A percutaneous endoscopic gastrostomy tube is used for clients who have difficulty swallowing and will need enteral nutrition for more than 4 weeks. Nasogastric, nasoduodenal, and nasojejunal tubes are used for clients who have difficulty swallowing and need enteral nutrition for 4 weeks or less.
What is one important difference between peripheral parenteral nutrition and central parenteral nutrition?
Peripheral vein solutions have a lower osmolality. Peripheral vein solutions generally have a lower osmolality than solutions that are infused through a central line. Fewer risks are associated with the use of a peripheral line versus a central line. Central line administration is used for long-term therapy. An infusion pump is necessary with parenteral therapy through either route.
The nurse is caring for a homeless older adult client who was admitted for severe malnourishment. The client's history is negative for kidney, liver, and lung disease, and he has no digestive issues. Which type of enteral formula should the nurse expect to see ordered? Polymeric Specialized Modular Oligomeric
Polymeric A polymeric enteric formula is prescribed for clients who are malnourished, but have no digestive issues. An oligomeric enteric formula is administered to clients who have digestion problems. A modular enteric formula supplies only one type of nutrient (carbohydrate, protein, or lipid). A specialized enteric formula is given to clients with specific nutritional needs, such as those who have disease of the kidney, liver, or lungs.
When the osmolality of plasma increases, what is triggered in addition to the thirstmechanism? Release of epinephrine Excretion of sodium chloride Release of antidiuretic hormone Excretion of bicarbonate
Release of antidiuretic hormone An increase in the osmolality of plasma indicates a concentration of solutes and the need for additional water. This condition triggers the thirst mechanism and the release of antidiuretic hormone. In turn, the kidneys reabsorb water and sodium chloride. The increase of osmolality in the plasma does not trigger the excretion of bicarbonate or sodium chloride. Epinephrine is not released as a direct response to increased osmolality of the plasma. Bicarbonate is excreted when aperson's serum pH level becomes higher than 7.45.
Shan Jung recently had a radical neck resection for throat cancer. He has a nasogastric tube and is receiving bolus enteral feedings. Mr. Jung complains of nausea and bloating. He asks you if there is anything that can be done to relieve the discomfort that accompanies his feedings. What should you tell Mr. Jung you will do?
Slow the rate of administration. Nausea and vomiting are most often caused by slowed gastric emptying. Decreasing the speed at which the feeding is administered is one of the nursing actions you can take to reduce these complications. Testing for Clostridium difficile. and adding fiber to the nutritional supplement are done if the client experiences diarrhea. Adding water to the feeding is done if the client is experiencing diarrhea. However, in this case, adding volume would exacerbate the symptoms.
What are common clinical manifestations of fluid volume deficit? Select all that apply. Tachycardia Decreased capillary refill Orthostatic hypotension Headache Nystagmus
Tachycardia Decreased capillary refill Orthostatic hypotension Common clinical manifestations associated with fluid volume deficit include tachycardia,orthostatic hypotension, decreased skin turgor, decreased capillary refill, dry mouth, and altered mental status. Nystagmus and headache are not common clinical manifestations associated with fluid volume deficit.
A client is experiencing a nonacute fluid volume deficit after walking to a nearby clinic for an appointment on a very warm summer day. The client feels slightly thirsty but does not feel lightheaded or have other problems. The nurse monitors the client's blood pressure and finds it to be slightly low (100/72 mmHg). To efficiently and comfortably bring the client's fluid volume back to a more normal level, which intervention would the nurse implement? IV administration of a hypertonic solution Inserting a feeding tube and administering fluids via the feeding tube IV administration of an isotonic solution Teaching the client to drink approximately 2,500 mL of water per day
Teaching the client to drink approximately 2,500 mL of water per day When a client is dehydrated (fluid volume deficit) and it is a nonacute situation, the nurse needs to teach the client to drink approximately 2,500 mL of water per day, especially when walking or exercising in the sun during the summer months. If the client is not able to drink approximately 2,500 mL of water per day, this amount of fluid can be administered through a feeding tube. However, there is no indication that this client is unable to drink fluids. During acute situations, isotonic IV fluids are administered to return blood volume and blood pressure to within normal parameters. A client experiencing a severe fluid volume deficit can develop hypovolemic shock if immediate fluid replacement is not administered. Administration of a hypertonic solution would make dehydration even worse, because it would draw more fluid from the cells into the intravascular space.
What does the nurse need to know before administering oral enteral nutrition? Select all that apply. That the client will adhere to the feeding plan That the client will need less direct nursing supervision That the client is able to swallow That a gastrostomy tube must be in place first That a central line must be placed
That the client will adhere to the feeding plan That the client will need less direct nursing supervision That the client is able to swallow The client must be able to swallow safely, to avoid aspiration, and must be able to adhere to the feeding plan, because the nurse cannot observe the client for every meal. Less direct nursing supervision is required. Neither a gastrostomy tube nor a central line is required for oral enteral nutrition therapy.
The nurse is administering blood products to a client who was admitted to the emergency department following a motor vehicle crash. Which assessment findings indicate adverse reactions to the blood product? The client reports that he feels anxious and is beginning to have difficulty breathing. The nurse notes that the client is developing slurred speech. The client reports that he has to urinate. The client reports that he is feeling lightheaded and "itchy." The client reports that his face, neck, and upper chest are red and feel warm.
The client reports that he feels anxious and is beginning to have difficulty breathing. The nurse notes that the client is developing slurred speech. The client reports that he is feeling lightheaded and "itchy." The client reports that his face, neck, and upper chest are red and feel warm. Adverse reactions to blood products include feeling lightheaded; itchiness or hives; flushing of the skin, especially of the face, neck, and upper chest; anaphylaxis, which may include feelings of anxiety and breathing problems; slurred speech; and confusion. A need to urinate is not an indication that the client is experiencing an adverse reaction to a blood product.
An adult client diagnosed with Crohn disease is receiving total parenteral nutrition (TPN). The nurse will need to monitor for which mechanical complication? Fluid volume overload Bone demineralization Refeeding syndrome Thromboembolism
Thromboembolism During parenteral nutrition therapy (TPN), clients are at risk for mechanical complications, such as thromboembolism, if the catheter is not correctly placed. Refeeding syndrome, fluid volume overload, and bone demineralization are metabolic, not mechanical, complications of TPN.
Total parenteral nutrition (TPN) is ordered for an adult client with a severe gastrointestinal disorder. The nurse expects that the solution will contain which nutrients? Select all that apply. Trace minerals Electrolytes Antibiotics Lipids Amino acids
Trace minerals Electrolytes Lipids Amino acids Lipids, electrolytes, amino acids, carbohydrates (dextrose 25-35% of solution), proteins, and vitamins are usually added to TPN, as well as trace minerals, such as zinc, copper, chromium, and manganese. TPN solutions are based on clients' nutritional needs, disease state, and laboratory results, and are modified daily. Antibiotics are not added to TPN.
Which nursing actions are taken to decrease the risk for infection at the parenteral administration site?
Use the TPN catheter only for TPN. Clean the insertion site area with an antimicrobial solution. Change the IV site of a peripheral line every 48 hours. To minimize the risk for infection, the IV site of a peripheral line should be changed every 48 hours, or as ordered, maintaining strict asepsis during the process. Swab the area around the catheter insertion site with an antimicrobial solution. Do not use the TPN catheter for any other form of monitoring, or for administration of medications or blood. Cover the insertion site with an occlusive dressing, which seals the site from contact with the air.
Parenteral nutrition may be administered by which route? Via central intravenous access Via the gastrointestinal system Via the oral route Via tube feeding
Via central intravenous access Parenteral nutrition is administered via intravenous access, usually through a central vein. Enteral nutrition is administered via the GI system, oral route, or tube feeding.
Sodium bicarbonate, 44 mEq times two IV bolus is ordered for Ms. Degrasso. As you administer the solution, for which common adverse effect should you monitor?
Vomiting Adverse reactions associated with the administration of sodium bicarbonate include confusion, irritability, decreased respiratory rate, and vomiting. Although hypercapnia may be associated with a severely depressed respiratory rate, it is not an adverse effect associated with the administration of sodium bicarbonate. Neither diarrhea nor hives is associated with sodium bicarbonate administration.
Which client would the nurse expect to receive total parenteral nutrition (TPN)? Fluid volume overload Bone demineralization Endocarditis Hemothorax Brachial plexus injury
client post-surgery for repair of knife wounds to the gastrointestinal system TPN is used for clients who are unable to eat and cannot tolerate enteral nutrition via the GI tract, such as clients with severe GI disorders, end-stage metastatic cancer, AIDS, burns, surgery, and/or trauma. TPN would not be used for an acute illness that is self-limiting, clients who can begin eating within a few days of surgery, or end-stage cancer clients in a hospice program.
The nurse is assessing an adult client who has been prescribed sodium bicarbonate as an antacid. Which side effects would the nurse discuss with the client? Electrolyte imbalances Confusion Decreased respiratory rate Mood elevation Irritability
ectrolyte imbalances Confusion Decreased respiratory rate Irritability Adverse effects of sodium bicarbonate include confusion, irritability, decreased respiratory rate, and electrolyte imbalances. Mood elevation is not an adverse effect of sodium bicarbonate.
