EAQ's Nutrition

The health care provider prescribes 1000 mL of total parenteral nutrition (TPN) to be administered in 12 hours. Based on this prescription, how many milliliters of solution will be administered per hour? a. 83 mL/h b. 100 mL/h c. 108 mL/h d. 125 mL/h

a. 83 mL/h Rationale: 83 mL/h is the correct calculation. 1000 mL of solution divided by 12 hours equals 83.3 mL/h. Always round to the nearest whole number. 100 mL/h is an incorrect calculation; it is too much solution per hour. 108 mL/h is an incorrect calculation; it is too much solution per hour. 125 mL/h is an incorrect calculation; it is too much solution per hour.

Which explanation would the nurse provide when administering total parenteral nutrition (TPN) to a client who asks why the solution is yellow? a. "Vitamin B complex makes it yellow." b. "Preservatives in the solution change its color." c. " I will have the pharmacist come to speak with you." d. "All TPN is yellow."

a. "Vitamin B complex makes it yellow." Rationale: Vit B complex is a yellow solution. When it is added to a base solution of TPN, it turns the solution yellow. Preservatives in intravenous (IV) solutions are colorless. Having the pharmacist come speak to the client abdicates the nurse's responsibility to answer the question. TPN is prescribed individually and may not always contain vit B complex and thus may not be yellow.

Which intervention would the nurse take to improve nutrition after identifying that a client receiving chemotherapy has lost weight? Select all that apply. a. Provide low-carbohydrate meals. b. Decrease fluid intake at mealtime. c. Encourage

c., d., & e. Rationale: Selecting preferred food increases the likelihood of the client eating the food. Small, frequent feedings are better tolerated than large meals. Antiemetics should be administered prophylactically to decrease nausea and enhance appetite. The diet should provide maximum protein and carbohydrates meet demands related to restoration of body cells and energy. Decreasing fluid intake may have deleterious effects.

Which information would the nurse include when teaching parents about the basic problem in celiac disease? a. Green stools b. Intolerance of gluten c. Absence of intestinal villi d. Susceptibility to severe dehydration

b. Intolerance of gluten Rationale: Celiac disease is an immunological small intestine enteropathy characterized by the inability to metabolize the gliadin component of gluten found in grains such as wheat, barley, rye, and oats; this result in excessive glutamine that is toxic to the mucosal cells. The stools are fatty and yellow. The intestinal villi are present but will atrophy if exposed to foods containing gluten. Fluid balance is not the basic problem w/ celiac disease; however, dehydration may occur in celiac crisis.

Which is the correct nursing intervention when caring for a 93-year-old client in a nursing home who has been eating less during mealtimes? a. Substitute a supplemental drink for the meal. b. Spoon-feed the client until the food is completely eaten. c. Allow the client a longer period of time to complete the meal. d. Arrange a consultation for the placement of a gastrostomy tube.

c. Allow the client a longer period of time to complete the meal. Rationale: Older clients may display psychomotor retardation and need more time to complete the tasks associated with the activities of daily living; mealtimes should be relaxing and social. Supplemental drinks should augment meals and be offered b/w meals, not as substitute for meals. Clients should be encouraged to feed themselves to remain as independent as possible; spoon-feeding may not mirror the pace of eating preferred by the client, and forcing the client to eat all of the food may precipitate anxiety, frustration, and agitation. Placement of a gastrostomy tube is premature.

After assessing several clients, the nurse would determine which client will require parenteral nutrition? a. A client with brain neoplasm b. A client with anorexia nervosa c. A client with inflammatory bowel disease d. A client with severe malabsorption disorder

d. A client with severe malabsorption disorder Rationale: A client w/ severe malabsorption disorder requires parenteral nutrition. Clients with a brain neoplasm, anorexia nervosa, or inflammatory bowel disease will require enteral nutrition.

Which statement explains why total parenteral nutrition (TPN) is infused through a central line rather than a peripheral line? a. It prevents the development of infection. b. There is less chance of this infusion infiltrating. c. It is more convenient, so clients can use their hands. d. The large amount of blood helps dilute the concentrated solution.

d. The large amount of blood helps dilute the concentrated solution. Rationale: Unless diluted by the increased blood flow, the highly concentrated solution can cause injury to the veins. The potential of infection is high w/ TPN b/c of the increased glucose levels. The other options are not the primary reason, although the infusion at this site is more secure and promotes free use of the arms and hands.

The home health nurse provides education for a client with cancer of the tongue who will begin gastrostomy feeding at home. Which client statement indicates effective teaching? a. "Before I start the procedure, I will done sterile gloves." b. "Before I start the procedure, I will obtain my body weight." c. "Before I start the procedure, I will measure the residual volume." d. "Before I start the procedure, I will instill 1 oz [30 mL] of a carbonated liquid."

c. "Before I start the procedure, I will measure the residual volume." Rationale: Measuring the residual volume establishes the absorption amount of the previous feeding. If a residual exceeds the parameter identified by the health care provider or is over 200 mL, a feeding may be held. This safety measure prevents adding excess feeding solution that may lead to abdominal distention, nausea, vomiting, and aspiration. Clean, not sterile gloves are necessary to protect the client from contamination with gastric secretions. The client obtains and reports weekly or monthly weights, depending on the client's condition and clinical goals. If the tube becomes clogged, the client may install 30 mL of a carbonated beverage; this action is not used routinely.

Which response would the nurse make to depressed older client who has not been eating well since admission to the hospital and repeatedly states, "No one cares"? a. "We all care about you; now please eat." b. "We all care about you; you have to eat to stay alive." c. "I care about you. What are some foods you especially like?" d. "I care about you. Will you please eat some of this food for me?"

c. "I care about you. What are some foods you especially like?" Rationale: The nurse would make the statement, "I care about you. What are some foods you especially like?" This is a direct response to the client's concern and permits some exploration of food choices. The nurse would not talk for others by saying, "we all care about you" and would not patronize the client by saying, 'now please eat." "We all care about you; you have to eat to stay alive," belittles the client's feelings. "I care about you. Will you please eat some of this food for me?" encourages dependence on the nurse; the message is "Do it for me, not b/c it is important for you."

Which instruction would be appropriate for the nurse to include when teaching client who is being prepared to be discharged with peripherally inserted central venous catheter (PICC) for administration of peripheral parenteral nutrition (PPN)? a. Learning how to change the percutaneous catheter b. Determining which days to self-administer the PPN solution c. Arranging for professional help to monitor the alternative nutrition d. Scheduling administration of the PPN solution around mealtimes

c. Arranging for professional help to monitor the alternative nutrition Rationale: Professional assistance will ensure correct administration, which may limit complications such as intravascular overload and sepsis; eventually, the client may self-administer the PPN w/ supervision. Changing the percutaneous catheter usually is done by an appropriate health care provider. PPN usually is administered every day. The PPN solution usually is administered as an intermittent infusion while the client is sleeping at night, not at mealtimes; this allows for independent movement during the day.

A client, admitted with full-thickness burns 2 weeks ago, has lost an average of 1 lb (0.5 kg) of weight each day. Which dietary adjustment would the nurse recommended? a. Increase low-sodium mile intake b. Provide high-protein drinks. c. Increase foods that are low in potassium. d. Provide 10% more calories in the form of fats.

b. Provide high-protein drinks. Rationale: High-protein drinks have twice the calories per volume of other fluids and provide protein for wound healing. Low-sodium milk does not contain adequate calories to help meet high metabolic rate associated w/ burns. Potassium is restricted during the first 48 to 72 hours after a burn injury, not 2 weeks after the injury. Increased calories in the form of protein and carbohydrates, not fats, are needed.

Which piece of equipment is essential for the nurse to obtain when preparing 1000 mL total parenteral nutrition (TPN) to be infused over 12 hours via a central venous access device? a. An infusion pump b. A steady intravenous (IV) pole c. An infusion set delivering 60 gtts/mL d. A set of hemostats to be taped at the bedside

a. An infusion pump Rationale: An infusion pump should be administered in a continuous and uniform infusion to prevent hyperosmolar diuresis. A steady IV pole is useful, but other alternatives are available (e.g., IV equipment such as a bulit-in that hangs from the ceiling or even placement of a pump on the bedside table). The tubing set should be specific for the type of infusion pump. Hemostats (clamps) are not necessary when administering TPN; an infusion pump should be used.

The nurse is caring for a client who is having difficulty digesting fatty foods. To which deficiency would the nurse attribute this problem? a. Bile b. Lipase c. Amylase d. Cholesterol

a. Bile Rationale: Fatty acids are insoluble and must combine w/ bile to form water-soluble substances. Lipase is a pancreatic enzyme. Amylase, which digests starch, is found in saliva and pancreatic juice. Although cholesterol is produced in the liver and stored in the gallbladder, it is not the component of bile that emulsifies fast.

Which food would the nurse encourage a client to eat while receiving treatment to prevent hypokalemia? a. Broccoli b. Oatmeal c. Fried rice d. Canned carrots

a. Broccoli Rationale: Potassium is plentiful in green leafy vegetables; broccoli provides 207 mg of potassium per half cup. Oatmeal provides 73 mg of potassium per half cup. Rice provides 29 mg of potassium per half cup. Cooked fresh carrots provide 172 mg of potassium per half cup; canned carrots provide only 93 mg of potassium per half cup.

Which medication is derived from a natural source and may be prescribed for the treatment of osteoporosis? a. Calcitonin b. Raloxifene c. Clomiphene d. Bisphosphonates

a. Calcitonin Rationale: Calcitonin is derived from natural sources such as fish; this medication may be prescribed to induce ovulation. Bisphosphonates are prescribed to treat osteoporosis. Clomiphene is prescribed to induce ovulation. Bisphosphonates are prescribed to treat osteoporosis; this medication is not derived from natural sources.

By which process would total parenteral nutrition (TPN) on an outpatient basis help a client with Crohn's disease prepare for surgery? a. Decreasing fecal bulk b. Preventing bowel infection c. Providing stimulation of secretions d. Maintaining negative nitrogen balance

a. Decreasing fecal bulk Rationale: By decreasing fecal bulk and bowel stimulation, TPN provides rest for the bowel while the client awaits surgery. TPN does not prevent a bowel infection. TPN does not stimulate gastrointestinal secretions. TPN promotes positive nitrogen balance.

A client describes abdominal discomfort after ingestion of milk. Which enzyme, as a result of a genetic deficiency, would the nurse consider to be the cause of the client's discomfort? a. Lactase b. Sucrase c. Maltase d. Amylase

a. Lactase Rationale: Milk and milk products are not tolerated well b/c they contain lactose, a sugar that is converted to galactose by lactase. Sucrase assists in the digestion of sucrose, which is not a mile sugar. Maltase assists in the digestion of maltose, which is not a milk sugar. Amylase assists in the digestion of starch, which is not a milk sugar.

Which information will the nurse include when providing education to the family of an adoescent who was recently diagnosed with type 2 diabetes mellitus? a. "Your teen will need insulin injections for the rest of her life." b. "The most important interventions are good nutrition and portion control." c. "This is a condition where the body produces antibodies against its own cells." d. "This condition causes weight loss and increased appetite, thirst, and urination."

b. "The most important interventions are good nutrition and portion control." Rationale: Most children w/ type 2 diabetes are overweight or at risk for becoming overweight. With nutritional intervention to promote proper weight, the condition may often be managed w/ diet and exercise alone. A lifelong insulin regimen, the production of antibodies against the child's own cells, and weight loss with increased appetite, thirst, and urination are all typical of type 1 diabetes.

The nurse teaches dietary guidelines to a client who will be receiving tranylcypromine sulfate, a monoamine oxidase inhibitor (MAOI). The client compiles a list of foods to avoid. Which foods included on the list indicate that the teaching has been effective? Select all that apply. One, some, or all responses may be correct. a. French fries b. Pepperoni pizza c. Bologna sandwich d. Hamburger on a bun e. Hash brown potatoes

b. & c. Rationale: Cheese and processed meats contain tyramine, which is contraindicated when MAOIs are taken. Tyramine, a precursor in the synthesis of norepinephrine, taken in the presence of MAOIs can lead to sharp increase in norepinephrine and potentially fatal hypertensive crisis. Although bread does not contain tyramine, bologna does; delicatessen meats (e.g., bologna and sausage), meat extracts, and liver are high in tyramine and should be avoided. French-fried potatoes, hamburgers, bread, and hash brown potatoes do not contain tyramine and are not contraindicated when a client is taking an MAOI.

One liter of 5% dextrose solution contains 50 grams of sugar. The nurse calculates that 3 L solution/day will supply approximately how many kilocalories? a. 400 b. 600 c. 800 d. 1000

b. 600 Rationale: Carbohydrates provide 4kcal/g; therefore 3 L x 50 g/L x 4 kcal/g=600 kcal, only about a third of the basal energy needed. Four hundred kilocalories are less than the kilocalories provided by the prescribed intravenous (IV) fluid. Eight hundred kilocalories and 1000 kilocalories are more than the kilocalories provided by the prescribed IV fluid.

Thick mucous gland secretions, elevated sweat electrolytes, meconium ileus, and difficulty maintaining and gaining weight are associated with which autosomal recessive disorder? a. Cerebral palsy b. Cystic fibrosis c. Muscular dystrophy d. Multiple sclerosis

b. Cystic fibrosis Rationale: The early symptom of cystic fibrosis is meconium ileus, which is impacted stool in the newborn. Thick mucous secretions, salty sweat, and difficulty gaining weight b/c of high caloric demands are characteristics of the condition. Cerebral palsy is. a motor disorder caused by damage to the brain. Muscular dystrophy is a muscular disorder. Multiple sclerosis is a condition with progressive disintegration of the myelin sheath.

After the nurse teaches a client, who is obese, measures to calculate the body mass index, which client statement indicates effective learning? Select all that apply. a. "I should include sugared beverages in my diet." b. I should loose at least half a pound to a pound each week." c. "My daily nutritional fat intake should be more than 30%." e. "I should stay away from unhealthy foods between meals and after dinner."

b., d., & e. Rationale: A client's BMI height-weight range is appropriate when it is w/in 10% of the ideal body weight. To achieve this, the client should lose at least 0.5 to 1 lb (0.2-0.45 kg) per week. The client's daily nutritional intake should meet the minimal dietary reference index. Refraining from eating unhealthy foods between meals and after dinner will help the client achieve an appropriate BMI. The client should avoid sugared beverages to achieve the appropriate BMI. Another effective way to achieve this is a daily fat intake less than 30% of total consumption.

Which statement about appropriate foods to consume when taking warfarin would indicate that the client needs further teaching? a. "Eggs provide a good source of iron, which is needed to prevent anemia." b. "Yellow vegetables are high in vitamin A and should be included in the diet." c. Dark green leafy vegetables are high in vitamin K, so I should eat them more often." d. "Milk and other high-calcium dairy products are necessary to counteract bone density loss."

c. "Dark green leafy vegetables are high in vitamin K, so I should eat them more often." Rationale: Foods high in vitamin K should be limited to the usual amounts eaten by the client when establishing the prothrombin time/international normalized ratio b/c vit K is part of the body's blood-clotting mechanism and will counter the effects of warfarin if eaten in excess. Foods containing protein and iron are permitted b/c they are unrelated to blood clotting. Foods containing vit A are permitted b/c vit A is unrelated to blood clotting. Foods containing calcium are permitted b/c calcium is unrelated to blood clotting.

Which statement by a client who is receiving total parenteral nutrition (TPN) after extensive colon surgery indicated effective teaching? a. "TPN provides supplemental nutrition." b. "TPN provides short-term nutrition after surgery." c. "TPN provides total nutrition when gastrointestinal function is questionable." d. "TPN assists people who are unable to eat but have active gastrointestinal function."

c. "TPN provides total nutrition when gastrointestinal function is questionable." Rationale: When GI absorption is inadequate, TPN is the nutritional therapy of choice b/c it provides needed nutrients. TPN is used for total, not supplemental, nutrition. TPN usually is used with chronic or long-term therapy, not for short-term therapy. The response "TPN assists people who are unable to eat but have active gastrointestinal function" is not the indication for TPN; a feeding tube would be used in this instance.

Which reason would the nurse identify as the purporse for using a central venous access device to administer total parenteral nurtrition (TPN) to a client with cancer of the pancreas? a. Infection is uncommon. b. It permits free use of the hands. c. The chance of the infusion infiltrating is decreased. d. The amount of blood in a major vein helps dilute the solution.

d. The amount of blood in a major vein helps dilute the solution. Rationale: Unless diluted, the highly concentrated solution can cause vein irritation or occlusion. Infection can occur at any invasive site and requires diligent care to avoid this complication. Although it permits free use of the hands, this is not the primary reason for a central line. The chance of the infusion infiltration decreasing is not the primary reason, although the infusion at this site is more secure than a peripheral site and promotes free use of the hands.

Which nutrients would the nurse teach the parents of a child with celiac disease to avoid? a. Saturated oils and fats b. Milk and cheeses c. Corn and rice products d. Wheat and oat products

d. Wheat and oat products Rationale: Wheat, oats, rye, and barley are major dietary sources of gluten; the gliadin fraction of these grains is not tolerated by individuals with celiac disease. There is no gluten in oils and fats. There is no gluten in cheeses and milk. Corn and rice are used as substitute grains b/c they do not contain gluten.