EAQ: Fundamentals Nutrition Questions
B To determine the length of the tube needed for a nasointestinal (NI) intubation, the nurse should add an additional 20 to 30 cm (8 to 12 in) to the measured length of the tube. Subtracting anything from the measured length and adding an 10 to 20 cm (4 to 8 in) will result in an inaccurate length.
How can the nurse determine the length of the tube needed for a nasointestinal (NI) intubation? A. Subtracting 10 to 20 cm (4 to 8 in) to the measured length of the tube B. Subtracting 20 to 30 cm (8 to 12 in) to the measured length of the tube C. Adding an additional 20 to 30 cm (8 to 12 in) to the measured length of the tube D. Adding an additional 10 to 20 cm (4 to 8 in) to the measured length of the tube
4
How much energy does 1 g of carbohydrate produce? Record your answer using a whole number. _________ kcal
A The patient's needs should be met in the order of priority. The pain due to oral ulcers should be a priority because this pain could affect the patient's nutritional intake and affect all other related interventions. Once the pain is relieved, the nutritional intake can be increased. Correcting a nutritional imbalance should be the second priority because it may affect other body systems. However, this diagnosis can be only addressed once the oral pain is relieved. Deficient knowledge regarding the diet therapy is the third priority. This diagnosis can only be addressed once the patient is relieved of pain. Constipation is the last priority. It can be addressed once the pain is relieved. The risk can be prevented by increasing the dietary intake and advising the patient on diet changes.
The nurse documents the following complaints following an initial assessment. Which would be a priority for meeting the patient's needs? A. Pain related to oral ulcers B. Insufficient nutrition for body requirements C. Deficient understanding of diet therapy D. Constipation related to reduced food intake
D When administering an enteral feeding to a patient who must remain supine, the nurse should place the patient in reverse Trendelenburg's position; keeping the patient's head elevated helps prevent aspiration. The Sim's, lithotomy, and high-Fowler's positions will not allow the patient to remain supine.
The nurse is administering an enteral feeding to a patient who must remain in a supine position. Which nursing action is appropriate? A. Placing the patient in Sim's position B. Placing the patient in a lithotomy position C. Placing the patient in high-Fowler's position D. Placing the patient in reverse Trendelenburg's position
B, C There is no perfect alternative to human breast milk. It is the best food for infants. Infant formulas contain the approximate nutrient composition of human milk. Honey should not be given to an infant, because it may be a source of botulinum toxin. The infant should not be given cow's milk, because it is deficient in iron and vitamin C and may increase the risk of anemia in the infant. In addition, the cow's milk is too concentrated for the infant's kidneys to handle. Infants fed cow's milk have an increased risk of developing kidney problems. Corn syrup is also a source of botulinum toxin and should be avoided.
The nurse is assessing the nutritional status of a 3-month-old baby. The mother informs the nurse that she feeds the baby with cow's milk mixed with one spoon of honey. What should the nurse advise this mother to do? Select all that apply. A. "Regularly give the baby toned cow's milk." B. "Switch to formula milk rather than cow's milk." C. "Stop giving honey to the baby." D. "Regularly give diluted cow's milk to the baby." E. "Give corn syrup instead of honey to the baby."
A, C, E When the patient coughs, the gastric contents may aspirate into the airways. Lying flat facilitates aspiration, because gastric content can easily enter the airways due to the airways position. Gastroesophageal reflux is a condition in which the gastric contents flow back into the esophagus. This can increase the risk of aspiration. Diarrhea is unrelated to the risk of aspiration. Administration of prokinetic drugs may actually decrease the risk of aspiration by promoting gastric emptying.
A patient is on enteral feedings through a nasogastric tube. Which factors increase the risk of aspiration in the patient? Select all that apply. A. Coughing B. Diarrhea C. Lying flat D. Administration of prokinetic drugs E. Gastroesophageal reflux disease
D NSAIDs decrease the level of vitamin C, which aids in the absorption of iron. These drugs also compete with folate and vitamin K and may cause gastritis. Excessive alcoholic beverage consumption can cause stomach irritation; alcohol would not be directly related to iron-deficiency anemia unless bleeding ulcers or gastritis were to occur. NSAID consumption, not stool softeners and laxative use, would be suspected in iron-deficiency anemia. Caffeinated foods and beverages can cause gastric irritation and discomfort but are not associated with iron-deficiency anemia.
A patient with arthritis develops iron-deficiency anemia. About what should the nurse ask the patient? A. Alcoholic beverages B. Stool softeners and laxatives C. Caffeinated foods and beverages D. Nonsteroidal anti-inflammatory drugs (NSAIDs)
A, C, E Patients with dysphagia are at risk for aspiration and need more assistance with feeding and swallowing. Feed the dysphagic patient slowly, providing smaller-sized bites, and allow the patient to chew thoroughly and swallow the bite before taking another. Position the patient in an upright, seated position in a chair or raise the head of the bed to 90 degrees. If the patient has unilateral weakness, teach the patient and the caregiver to place food in the stronger side of the mouth. Additional interventions include providing a 30-minute rest period before eating. Have the patient slightly flex the head to a chin-down position to help prevent aspiration. Determine the viscosity of foods that the patient tolerates best by trying different consistencies of foods and fluids. Thicker fluids are generally easier to swallow. More frequent chewing and swallowing assessments throughout the meal are necessary. Allow the patient time to empty the mouth after each spoonful, matching the speed of feeding to the patient's readiness. If the patient begins to cough or choke, remove the food immediately.
The nurse is caring for a patient experiencing dysphagia. Which interventions help decrease the risk of aspiration during feeding? Select all that apply. A. Sit the patient upright in a chair. B. Give liquids at the end of the meal. C. Place food in the stronger side of the mouth. D. Provide thin foods to make it easier to swallow. E. Feed the patient slowly, allowing time to chew and swallow. F. Encourage patient to lie down to rest for 30 minutes after eating.
B The admixture for PN consists of fat emulsions, and it normally is white and opaque. The presence of oil droplets or an oily or creamy layer on the surface of the admixture indicates that the emulsion has broken into large lipid droplets. These lipid droplets may cause fat emboli if the admixture is administered. Therefore, the nurse should discard the admixture and obtain another admixture to administer to the patient. Shaking the container may not convert the large lipid droplets into emulsions. The PN solution should not be used for enteral feeding, because it may not be absorbed. The admixture should not be administered to another patient; it should be discarded.
The nurse is caring for a patient who is on parenteral nutrition (PN). The nurse finds that the PN admixture has an oily layer on the surface. What is the most appropriate nursing action in this situation? A. Shake the container well and administer the admixture. B. Discard the admixture and administer another admixture. C. Use the admixture for enteral feeding for the patient. D. Use the admixture for another patient on PN.
C, E Anorexia nervosa is an eating disorder in which people refuse to maintain body weight over a minimal normal weight for the age and height. These people may think of themselves as too fat though they are underweight. To maintain the desired body weight, they may fast, exercise more, and eat minimally. Bulimia nervosa is characterized by a lack of control over eating behavior. There may be periods of binge eating followed by self-induced vomiting to prevent weight gain. A loss of appetite is called anorexia. Diabetes mellitus is not an eating disorder; it is a metabolic disorder. Obesity is not an eating disorder, but it may be caused by an eating disorder.
The nurse is conducting a health awareness program on eating disorders. What are the examples of eating disorders? Select all that apply. A. Anorexia in teens B. Diabetes mellitus C. Anorexia nervosa D. Obesity in children E. Bulimia nervosa
B, D, E, C, A The first nursing action when intubating a patient with a feeding tube is to perform hand hygiene and apply clean gloves. The second action is to insert the tube through the nostril to the back of the patient's throat. Next, the nurse should encourage the patient to swallow by giving him or her small sips of water when advancing the tube. The following step is to stop, hold the end of the tube near the ear, and listen for air exchange when the tip of the tube reaches the carina. Finally, the nurse should anchor the tube to the patient's nose.
The nurse is intubating a patient with a feeding tube. In which order should the nurse perform the following actions? The nurse is intubating a patient with a feeding tube. In which order should the nurse perform the following actions? A. Anchor the tube to the patient's nose. B. Perform hand hygiene, and apply clean gloves. C. Stop, hold the end of the tube near the ear, and listen for air exchange when the tip of the tube reaches the carina. D. Insert the tube through the nostril to the back of the patient's throat. E. Encourage the patient to swallow by giving him or her small sips of water while advancing the tube.
14 The Mini Nutritional Assessment (MNA®) can be used for screening the nutritional status of older adults. The maximum score is 14. If the score is from 12 to 14 points, it is considered a normal nutritional status. If the score is between 8 and 11 points, the patient is at risk of malnutrition. A total score of less than 7 points indicates malnutrition.
The nurse is learning about the Mini Nutritional Assessment (MNA®). What is the highest score in the test? Record your answer using a whole number. __________
C Rice does not contain gluten and can be added to the diet plan. Gluten is present in wheat, rye, barley, and oats, so they should be avoided in patients with celiac disease or patients with gluten intolerance. Gluten can result in malabsorption and nutritional deficiencies in the patient.
The nurse is preparing a diet plan for a patient diagnosed with gluten intolerance. What food item can be included in the diet plan? A. Wheat B. Oats C. Rice D. Barley
B Patients receiving enteral feedings should have the head of the bed elevated a minimum of 30 degrees, preferably 45 degrees, unless medically contraindicated. Laying the patient supine increases the risk of aspiration of the feeding and should be avoided. This needs to be addressed to maintain patient safety.
The nurse sees the nursing assistive person (NAP) perform the following for a patient receiving continuous enteral feedings. What intervention does the nurse need to address immediately with the NAP? A. The NAP fastens the tube to the gown with tape. B. The NAP places the patient supine while giving a bath. C. The NAP performs oral care for the patient. D. The NAP elevates the head of the bed 45 degrees.
A Lysine is an indispensable amino acid, which means the body does not synthesize it and it must be part of a healthy diet. Alanine, asparagine, and glutamic acid are dispensable amino acids. The body synthesizes dispensable amino acids.
Which amino acid is indispensable? A. Lysine B. Alanine C. Asparagine D. Glutamic acid
B, D, E
Which data should the nurse document in the medical record when providing care to a patient who is receiving enteral tube feedings? Select all that apply. A. Goal weight B. Patency of the tube C. Most recent vital signs D. Amount and type of tube feeding E. Condition of the skin at the site of the tube
B An air embolus possibly occurs during insertion of the catheter or when changing the tubing or cap. Have the patient assume a left lateral decubitus position first. Then have the patient perform a Valsalva maneuver (holding the breath and bearing down). The increased venous pressure created by the maneuver prevents air from entering the bloodstream during catheter insertion. Maintaining the integrity of the closed intravenous system also helps prevent an air embolus. Notifying the health care provider is important and would need to be done, although not immediately. Safety is the immediate priority, which the correct answer addresses.
The nurse suspects that the patient receiving parenteral nutrition (PN) through a central venous catheter (CVC) has an air embolus. What action does the nurse need to take first? A. Raise the head of the bed to 90 degrees. B. Turn the patient to left lateral decubitus position. C. Notify the health care provider immediately. D. Have the patient perform the Valsalva maneuver.
A, B, C, E Regular exercise, physical activities, and sports are all essential for burning calories and reducing weight. Junk foods are excessively fatty, so these should be avoided. Carbohydrate content should be increased in the diet when exercising because carbohydrates are a major source of energy.
The nurse works at a weight loss clinic. A teenage girl approaches the nurse for advice on weight loss. Which instructions should the nurse give to the teenager to help reduce her weight? Select all that apply. A. Engage in regular exercise. B. Participate in outdoor sports. C. Include physical activities in your daily routine. D. Decrease carbohydrate content in the diet when exercising. E. Ovoid excessive consumption of junk foods.
A During the assessment phase of the nursing process for a patient diagnosed with malnutrition, the nurse needs to determine the patient's nutritional energy needs. The nurse involves the patient's family members in designing the intervention during the planning phase of the nursing process. Also during the planning phase, the nurse selects the nursing interventions consistent with therapeutic diets. During the evaluation phase, the nurse reassesses signs and symptoms associated with altered nutrition.
What action is part of the assessment phase when caring for a patient diagnosed with malnutrition? A. Determine the patient's nutritional energy needs. B. Involve the patient's family when designing interventions. C. Select nursing interventions consistent with therapeutic diets. D. Reassess signs and symptoms associated with altered nutrition.
B, E When evaluating a patient treated for malnutrition, the nurse determines the patient's satisfaction with the nutritional therapy and reassesses signs and symptoms associated with the altered nutrition plan. During the assessment phase of the nursing process, the nurse will have determined the patient's nutritional energy needs and will have gathered data from the patient regarding nutritional practices. During the planning phase, the nurse will have selected nursing interventions consistent with the therapeutic diet.
What does the nurse do when evaluating a patient who has been treated for malnutrition? Select all that apply. A. Determines the patient's nutritional energy needs. B. Determines the patient's satisfaction with nutritional therapy. C. Gathers data from the patient regarding nutritional practices. D. Selects nursing interventions consistent with therapeutic diets. E. Reassesses signs and symptoms associated with altered nutrition.
22.5 The BMI of a patient is obtained by dividing the patient's weight in kilograms by height in meters squared: weight (kg)/height2 (m2). Therefore, 90 ÷ 22 = 22.5
What is the body mass index (BMI) of a patient who is 90 kg (198.5lb) in weight and 2.0m (6.57 ft) tall? Record your answer up to one decimal place. ____
A, B, C, E Nursing actions that are appropriate when feeding a patient who is prescribed aspiration precautions include: telling the patient to open his or her mouth; encouraging the patient to feel the food in his or her mouth; asking the patient to cough in order to clear the airway; and teaching the patient to raise the tongue to the roof of the mouth when eating. The nurse should provide more time and rest periods as needed rather than rushing the patient through a meal.
Which actions should the nurse implement when feeding a patient who is prescribed aspiration precautions? Select all that apply. A. Telling the patient to open his or her mouth B. Encouraging the patient to feel the food in his or her mouth C. Asking the patient to cough in order to clear the airway D. Rushing the patient to finish the meal as soon as possible E. Teaching the patient to raise his or her tongue to the roof of the mouth when eating
A The body does not synthesize lysine, which is an indispensable amino acid that should be part of a healthy diet. Alanine, asparagine, and glutamic acid are dispensable amino acids, which are synthesized by the body.
Which amino acid does the body not synthesize? A. Lysine B. Alanine C. Asparagine D. Glutamic acid
A Polymeric formula consists of milk-based, blended foods and can be prepared by hospital dietary staff or in a patient's home. These formulas are appropriate for patients who have functional gastrointestinal tracts. Modular formulas consist of single macronutrient preparations. These formulas are incomplete and do not meet nutritional requirements. Elemental formulas contain predigested nutrients that make digestion easier for the patient with a partially dysfunctional gastrointestinal (GI) tract. Specialty formulas consist of specific nutrients to meet specific nutritional needs.
Which enteral formula type consists of milk-based, blended foods and can be prepared by hospital dietary staff or in a patient's home? A. Polymeric formula B. Modular formula C. Elemental formula D. Specialty formula
C Environmental factors such as limited access to grocery stores, the ease and widespread availability of fast food, and a lack of safe places to play or exercise may inhibit a person's likelihood of healthy eating, exercising, and making other healthy living choices. Genetic factors, geographic area, and educational level do not necessarily limit a person's ability to choose healthy lifestyle habits.
Which factor most inhibits a person's likelihood to make healthy living choices? A. Genetic factors B. Geographic area C. Environmental factors D. Educational level
B The priority nursing action when intubating a patient with a feeding tube is to verify the health care provider's order; this is the first requirement for implementing any procedure. Clean, not sterile, gloves are needed when performing this procedure. The nurse should determine the patient's knowledge of the procedure and review the medical record for history of nasal problems; however, these actions are performed after verifying the provider's order for the feeding tube.
Which is the priority nursing action when intubating a patient with a feeding tube? A. Donning sterile gloves B. Verifying the health care provider's order C. Determining the patient's knowledge of the procedure D. Reviewing the patient's medical record for a history of nasal problems
A The patient who experiences pulmonary aspiration due to enteral feedings should have his or her airway suctioned by the nurse. Conferring with a dietician is appropriate for a patient who develops frequent diarrhea. Flushing the tube with water is appropriate for a patient whose enteral feeding tube is clogged. Instituting skin care measures is appropriate for a patient who develops diarrhea and is at risk for perianal excoriation.
Which nursing action is appropriate when providing care to a patient who experiences pulmonary aspiration due to enteral feedings? A. Suctioning the airway B. Conferring with a dietician C. Flushing the tube with water D. Instituting skin care measures
C The appropriate nursing action when providing care to a patient who is prescribed intermittent tube feedings is to check tube placement prior to each feeding. An x-ray film is often obtained to confirm placement prior to the initial tube feeding and before any feeding where the placement of the tube is questioned, but it is not necessary after each feeding. Tube placement is monitored every 4 to 6 hours for patients who are prescribed continuous, not intermittent, tube feedings. The tube is flushed with 30, not 15, mL of water to avoid clogging.
Which nursing action is appropriate when providing care to a patient who is prescribed intermittent tube feedings? A. Obtaining an x-ray film after each feeding B. Monitoring tube placement every 4 to 6 hours C. Checking tube placement prior to each feeding D. Flushing the tube with 15 mL of water to avoid clogging
B When removing an enteral feeding tube from the patient, the nurse should pull the tube steadily and smoothly. The patient should be placed in high-Fowler's, not low-Fowler's, position. The end of the patient's tube should be kinked, not straightened. The patient should be instructed to take a deep breath and hold it, not exhale.
Which nursing action is appropriate when removing an enteral feeding tube from the patient? A. Placing the patient in low-Fowler position B. Pulling the patient's tube steadily and smoothly C. Straightening the end of the patient's tube securely D. Instructing the patient to take a deep breath and exhale
C Which nursing action supports safety guidelines that are essential when providing care to a patient who is receiving a tube feeding? 1 Using surgical aseptic technique 2 Placing the patient's head of the bed at 90 degrees Correct3 Allowing the open formula system to hang for no more than 8 hours 4 Adding food coloring to enteral nutrition to decrease the risk for hypotension An open formula system can hang for up to 8 hours; this is the nursing action that supports safety guidelines that are essential when providing care to a patient who is receiving a tube feeding. Medical, not surgical, aseptic technique is the expectation for this type of care. The head of the patient's bed should be placed at 30 to 45 degrees, not 90 degrees. Food coloring should be avoided, because it can cause hypotension, not decrease its risk.
Which nursing action supports safety guidelines that are essential when providing care to a patient who is receiving a tube feeding? A. Using surgical aseptic technique B. Placing the patient's head of the bed at 90 degrees C. Allowing the open formula system to hang for no more than 8 hours D. Adding food coloring to enteral nutrition to decrease the risk for hypotension
A, D The nurse should verify the patient using two identifies (i.e., patient's name and birthday or name and medical record number) according to agency policy. This can be accomplished by asking the patient to state his or her name and birth date or by comparing the patient's name and medical record number on the order to the ID band placed on the patient's wrist. Asking the patient if his name is Mr. Jones elicits a yes or no answer and is not supported by the Joint Commission, because it can result in mistakes. The patient's identity should not be verified by a family member, and the patient should not be asked compare medical record number and name to the provider's order, because this requires the ability to read.
Which nursing actions appropriately identify a patient prior to inserting a prescribed nasoenteric tube? Select all that apply. A. Asking the patient to state his or her name and birth date B. Asking the patient if he is Mr. Jones and to state his date of birth C. Verifying the patient's name and social security number by asking a family member D. Comparing the patient's name and medical record number on the order to the ID band E.Asking the patient to compare the medical record number and name to the provider's order
A, B, D, E During an enteral feeding, the nurse should instruct nursing assistive personnel (NAP) to report choking, gagging, and coughing, because these may indicate that the patient has aspirated. The nurse should also instruct NAP to report any patient discomfort. Sneezing is not of particular concern during the administration of an enteral feeding.
Which patient behaviors should the nurse instruct nursing assistive personnel (NAP) to report during the administration of an enteral feeding? Select all that apply. A. Choking B. Gagging C. Sneezing D. Coughing E. Discomfort
A, C, E Dysphagia refers to abnormal swallowing, which can lead to aspiration. Coughing during eating indicates that food has entered the respiratory tract. Abnormal lip movements can indicate an abnormal swallowing reflex. A change in voice tone after swallowing is caused by the food entering the respiratory tract. Speaking consistently and having coordinated speech indicate a normal swallowing reflex.
Which patients are at high risk of dysphagia? Select all that apply. A. A patient who coughs during eating B. A patient who speaks consistently C. A patient who has abnormal lip movements D. A patient who has coordinated and precise speech E. A patient with a change in voice tone after swallowing
C Dextrose is a monosaccharide, a simple carbohydrate that does not break down into more basic carbohydrate units. Fiber, starch, and glycogen are polysaccharides, or complex carbohydrates that are insoluble in water and digested to varying degrees.
Which substance is a monosaccharide? A. Fiber B. Starch C. Dextrose D. Glycogen
A, B, D A disaccharide is composed of two monosaccharide units and water. Sucrose, lactose, and maltose are disaccharides. Glucose and fructose are examples of monosaccharaides, the most basic carbohydrate units.
Which substances are disaccharides? Select all that apply. A. Sucrose B. Lactose C. Glucose D. Maltose E. Fructose
A, C, E Oats, barley, and cornmeal are soluble fibers, which can be dissolved in water. Lignin and cellulose are insoluble fibers, which cannot be dissolved in water and are not digestible.
Which substances are soluble fibers? Select all that apply. A. Oats B. Lignin C. Barley D. Cellulose E. Cornmeal