Adaptive Quizzing Chapter 45 Nutrition and the nursing process

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. ____

22.5

A patient is 5 feet, 10 inches tall, and has a weight of 70 kg. What would be the body mass index (BMI) of the patient? Do your calculations and record your answer using two decimal places. __________ kg

22.09

Following cardiac surgery, a patient is on a diet to reduce cholesterol. What is the recommended cholesterol intake in this diet? Record your answer using a whole number. __________ mg/day

300

What is the maximum hang time for enteral feeding in an open system? Record your answer using whole number. _____ hours

8

The nurse is caring for a patient with dysphagia. Of what complications of dysphagia should the nurse be aware? Select all that apply. Aspiration pneumonia Dehydration Decreased nutritional status Weight loss Gastrointestinal infection

Aspiration pneumonia Dehydration Decreased nutritional status Weight loss

A patient is diagnosed with myasthenia gravis. The patient has difficulty swallowing due to this condition. For what complications of dysphagia should the nurse be observant? Select all that apply. Aspiration pneumonia Dehydration Weight loss Dental caries Gastric ulcers

Aspiration pneumonia Dehydration Weight loss

Following cardiac surgery, a patient is kept on nothing by mouth for 3 days. What should be the sequence of diet progression in this patient? Full liquid Low residue diet Mechanical soft Pureed diet Clear liquid

Clear liquid Full liquid Pureed diet Mechanical soft Low residue diet

A 70-year-old patient is admitted to the hospital post stroke. The patient suffers from right-sided hemiplegia and dysphagia. Which complication of dysphagia might the nurse observe in the patient? Aspiration pneumonia Excess fluid intake Improved nutritional status Weight gain

Aspiration Pneumonia

A patient is on enteral feedings through a nasogastric tube. Which factors increase the risk of aspiration in the patient? Select all that apply. Coughing Diarrhea Lying flat Administration of prokinetic drugs Gastroesophageal reflux disease

Coughing Lying Flat Gastroesophageal reflux disease

What does the nurse do when evaluating a patient who has been treated for malnutrition? Select all that apply. Determines the patient's nutritional energy needs. Determines the patient's satisfaction with nutritional therapy. Gathers data from the patient regarding nutritional practices. Selects nursing interventions consistent with therapeutic diets. Reassesses signs and symptoms associated with altered nutrition.

Determines the patients satisfaction with nutritional practices Reassesses signs and symptoms associated with altered nutrition

What are the indications for enteral nutrition? Select all that apply. Severe pancreatitis Severe malabsorption Difficulty chewing Prolonged intubation Anorexia nervosa

Difficulty chewing Prolonged intubation Anorexia nervosa

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? Shake the container well and administer the admixture. Discard the admixture and administer another admixture. Use the admixture for enteral feeding for the patient. Use the admixture for another patient on PN.

Discard the admixture and administer another admixture

A 70-year-old hypertensive patient came to the clinic for a regular checkup. On assessment, the nurse finds that the patient has experienced a weight loss of 5 pounds and has a poor nutritional status. Which physical signs are indicative of poor nutritional status? Select all that apply. Dry scaly lips Pain in the chest region Flaccid, wasted muscles Tiredness after climbing stairs Spoon-shaped and brittle nails

Dry scaly lips Flaccid wasted muscles Spoon-shaped and brittle nails

The nurse is caring for a patient diagnosed with hemorrhoids. While taking the patient's clinical history and vitals, the nurse finds that the patient has chronic constipation. What should the nurse teach the patient about the diet? Select all that apply. Food rich in fiber relieves constipation. Fibers contribute calories to the body. Fluid and fiber intake should be increased. Fiber is well digested by humans. Fruits and vegetables relieve constipation.

Foods rich in fiber relieves constipation Fluid and fiber intake should be increased Fruits and vegetables relieve constipation

Which factor contributes to peptic ulcer formation? Spicy foods Decreased gastrin production Increased bicarbonate retention Helicobacter pylori infection

Helicobacter pylori infection

The nurse is caring for a patient who is on tube feeding. What signs and symptoms suggest intolerance to feedings? Select all that apply. High gastric residual Nausea Vomiting Constipation Cramping

High gastric residual Nausea Vomiting Cramping

A 70-year-old patient came to the clinic for a regular checkup. The patient lives alone. On assessment, the nurse finds that the patient has experienced a weight loss of 5 pounds and has a poor nutritional status. The nurse decides to assess the food preferences and dietary intake of this patient. Which questions should the nurse ask the patient? Select all that apply. "How do you prepare your food?" "How many meals do you have in a day?" "Do you buy food from the nearby store?" "How many hours after eating do you go to bed?" "Do you follow any special diet due to your medical condition?"

How do you prepare your food How many meals do you have in a day Do you follow any special diet due to your medical condition

The nurse is caring for a patient who is on antifungal medication. The patient complains of nausea and loss of appetite. What interventions should the nurse perform to promote appetite in the patient? Select all that apply. Maintain an odor-free environment. Provide regular oral care. Make the patient comfortable. Provide a liquid diet. Provide three large meals

Maintain an odor-free enviornment Provide regular oral care Make the patient comfortable

A nurse must administer enteral feeding via nasoenteric tube to a patient. In what order should the nurse perform the procedure? -Identify the patient using two identifiers according to agency policy. -Attach the syringe, and aspirate 5 mL of gastric contents. -Monitor the intake and output every eight hours, and calculate daily totals every 24 hours. -Obtain baseline weight and laboratory values to assess the nutritional status of the patient.

Obtain baseline weight and laboratory values to assess the nutritional status of the patient Identify the patient using two identifiers according to agency policy Attach the syringe, and aspirate 5 mL of gastric contents Monitor the intake and output every eight hours, and calculate daily totals every 24 hours

The nurse documents the following complaints following an initial assessment. Which would be a priority for meeting the patient's needs? Pain related to oral ulcers Insufficient nutrition for body requirements Deficient understanding of diet therapy Constipation related to reduced food intake

Pain related to oral ulcers

Which enzyme do the chief cells of the stomach secrete? Secretin Pepsinogen Intrinsic factor Cholecystokinin

Pepsinogen

In what order does the nurse implement the following steps while administering enteral feedings via nasoenteric tube? -Flushing the tubing with 30 mL water -Placing the patient in high-Fowler's position -Rinsing the bag and tubing with warm water whenever feedings are interrupted -Advancing the rate of tube feeding gradually, as ordered by the health care provider -Verifying tube placement by attaching the syringe and aspirating 5 mL of gastric contents -Initiating feeding by removing the plunger from the syringe and attaching the barrel of syringe to the end of tube

Placing the patient in high-Fowlers position Verifying tube placement by attaching the syringe and aspirating 5 mL of gastric contents Flushing the tubing with 30 mL water Initiating feeding by removing the plunger from the syringe and attaching the barrel of syringe to the end of tube Advancing the rate of tube feeding gradually as ordered by the health care provider Rinsing the bag and tubing with warm water whenever feedings are interrupted

The nurse has a new order to monitor blood glucose on a patient, so the nurse provides information about the procedure and purpose to the patient before taking the first measurement. Which phase of the nursing process is represented? Planning Evaluation Assessment Implementation

Planning

Which enteral formula type consists of milk-based, blended foods and can be prepared by hospital dietary staff or in a patient's home? Polymeric formula Modular formula Elemental formula Specialty formula

Polymeric formula

What does the nurse do during the planning phase for a patient diagnosed with malnutrition? Determines the patient's satisfaction with the nutritional therapy Gathers data from the patient regarding nutritional practices Selects nursing interventions consistent with the therapeutic diet Reassesses signs and symptoms associated with altered nutrition

Select nursing interventions consistent with the therapeutic diet

The nurse is caring for a patient experiencing dysphagia. Which interventions help decrease the risk of aspiration during feeding? Select all that apply. Sit the patient upright in a chair. Give liquids at the end of the meal. Place food in the stronger side of the mouth. Provide thin foods to make it easier to swallow. Feed the patient slowly, allowing time to chew and swallow. Encourage patient to lie down to rest for 30 minutes after eating.

Sit the patient upright in a chair Place food in the stronger side of the mouth Feed the patient slowly allowing time to chew and swallow

A postoperative patient is advised to take clear fluids. What types of fluids should the nurse provide to the patient? Select all that apply. Tea Coffee Carbonated beverages Vegetable juices Blended cream soups

Tea Coffee Carbonated beverages

The nurse is helping a patient with vision impairment to feed himself. What nursing actions would help the patient maintain independence during feeding? Select all that apply. Allow the patient to eat independently without any instructions. Tell the patient where the beverages are located in relation to the plate. Identify the food location on a meal plate as if it were a clock. Ensure the other care providers set the meal tray and plate in the same manner. Encourage the use of large-handled adaptive utensils

Tell the patient where the beverages are located in relation to the plate Identify the food location on a meal plate as if it were a clock Ensure the other care providers set the meal tray and plate in the same manner encourage the use of large-handled adaptive utensils

The catheter of the patient receiving parenteral nutrition (PN) becomes occluded. Place the steps for caring for the occluded catheter in the order in which the nurse would perform them. Attempt to aspirate a clot. Temporarily stop the infusion. Use a thrombolytic agent if ordered or per protocol. Flush the line with saline or heparin.

Temporarily stop the infusion Flush the line with saline or heparin Attempt to aspirate a clot Use a thrombolytic agent is ordered or per protocol

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? The NAP fastens the tube to the gown with tape. The NAP places the patient supine while giving a bath. The NAP performs oral care for the patient. The NAP elevates the head of the bed 45 degrees

The NAP places the patient supine while giving a bath

The nurse is feeding a patient with dysphagia. Which action performed by the nurse during feeding may lead to aspiration? The nurse raises the head of the bed to 90 degrees. The nurse extends the patient's head to a chin-up position. The nurse places the food on the stronger side of the mouth. The nurse provides the patient with thicker fluids to drink.

The nurse places the patients head to a chin-up position

The nurse weighs a patient with renal failure and finds the body weight to be 112 pounds. The patient's weight on the previous day was 110 pounds. What should the nurse interpret from the finding? The patient has retained a liter of fluids. The patient has had a healthy weight gain. The patient's kidney function has improved. The patient has not passed urine for a long time

The patient has retained a liter of fluids

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? Raise the head of the bed to 90 degrees. Turn the patient to left lateral decubitus position. Notify the health care provider immediately. Have the patient perform the Valsalva maneuver.

Turn the patient to the left lateral decubitus position

What is the most important nursing intervention that the nurse should provide to a patient who is diagnosed with ineffective coping related to improper nutrition? Teaching the patient about dietary guidelines Encouraging the patient to take a short afternoon nap Using an active listening approach when talking with the patient Encouraging the patient to contact a friend and take a walk every day

Using an active listening approach when talking with the patient

The nurse has inserted a nasogastric tube into a patient. However, when the first feeding is administered, the patient has pulmonary aspiration. Which action would have prevented this complication? Starting the enteral feeding at a slow rate Administering a milk-based formula Verifying the placement of the tube through x-ray Auscultating the bowel sounds before feeding

Verifying the placement of the tube through x-ray

The nurse is collecting a sample of gastric contents to determine the pH for a patient who is on enteral feeding through a nasogastric tube. Arrange the actions performed by the nurse in the correct order. -Flush the feeding tube using a syringe with 30 mL of air. -Wash hands thoroughly and put on gloves. -Expel a few drops in a clean medicine cup. -Discard gloves and wash hands. -Aspirate 5 mL to 10 mL of gastric aspirate with a syringe. -Dip the pH strip into the aspirate in the medicine cup and observe the color.

Wash hand thoroughly and put on gloves Flush the feeding tube using a syringe with 30 mL of air Aspirate 5mL to 10mL of gastric aspirate with a syringe expel a few drops in a clean medicine cup dip the pH strip into the aspirate in the medicine cup and observe the color Discard gloves and wash hands

Which food items contain gluten and should be avoided in patients with celiac disease? Select all that apply. Wheat Rye Barley Oats Rice

Wheat Rye Barley Oats

BMI equation

weight (kg) / height (m2)

What test should be performed to confirm the correct placement of a nasogastric (NG) feeding tube before the start of feedings? An x-ray study Auscultation of the abdomen Assessment of stomach content pH Assessment of residual stomach contents

An x-ray study

The nurse is inserting a central catheter into a patient to provide parenteral nutrition (PN). The nurse places the patient in a left lateral decubitus position, and instructs the patient to hold her breath and bear down during catheter insertion. What is the most probable reason the nurse put the patient in that position and asked her to hold her breath and bear down? It helps to prevent air embolism. It promotes the patient's comfort. It promotes lung expansion. It prevents pulmonary aspiration

It helps to prevent air embolism

Which action is initially taken by the nurse to verify the correct position of a recently placed small-bore feeding tube? Refer to the doctor to order for x-ray film examination to check position Confirming the distal mark on the feeding tube after taping Testing the pH of the gastric contents and observing the color Auscultating over the gastric area as air is injected into the tube

Refer to the doctor to order for x-ray film examination to check position