Chapter 40 - Nursing Management: Nutritional Problems

A patient with anorexia nervosa shows signs of malnutrition. During initial refeeding, the nurse carefully assesses the patient for a. hyperkalemia. b. hypoglycemia. c. hypercalcemia. d. hypophosphatemia.

Correct answer: d Rationale: Refeeding syndrome is characterized by fluid retention, electrolyte imbalances (e.g., hypophosphatemia, hypokalemia, hypomagnesemia), and hyperglycemia. Conditions that predispose patients to refeeding syndrome include long-standing malnutrition states such as those induced by chronic alcoholism, vomiting and diarrhea, chemotherapy, and major surgery. Refeeding syndrome can occur any time a malnourished patient is started on aggressive nutritional support. Hypophosphatemia is the hallmark of refeeding syndrome, and it is associated with serious outcomes, including cardiac dysrhythmias, respiratory arrest, and neurologic disturbances (e.g., paresthesias).

The percentage of daily calories for a healthy individual consists of: a. 50% carbohydrates, 25% protein, 25% fat, and <10% of fat from saturated fatty acids. b. 65% carbohydrates, 25% protein, 25% fat, and >10% of fat from saturated fatty acids. c. 50% carbohydrates, 40% protein, 10% fat, and <10% of fat from saturated fatty acids. d. 40% carbohydrates, 30% protein, 30% fat, and >10% of fat from saturated fatty acids.

Correct answer: a Rationale: The 2005 Dietary Guidelines for Americans recommend that 45% to 65% of total calories should come from carbohydrates. Ideally, 10% to 35% of daily caloric needs should come from protein. Individuals should limit their fat intake to 20% to 35% of total calories. Additional recommendations focus on the type of fat consumed because diets high in excess calories, usually in the form of fats, contribute to the development of obesity. Individuals should consume less than 10% of calories from saturated fatty acids, limit intake of fat and oils high in trans fatty acids, and should limit intake of dietary cholesterol to 300 mg/day.

The nurse confirms initial placement of a blindly inserted smallbore NG feeding tube by a. x-ray. b. air insufflation. c. observing patient for coughing. d. pH measurement of gastric aspirate.

Correct answer: a Rationale: The nurse should obtain x-ray confirmation to determine whether a blindly placed nasogastric or orogastric tube (small bore or large bore) is properly positioned in the gastrointestinal tract before administering feedings or medications.

A patient is receiving peripheral parenteral nutrition. The parenteral nutrition solution is completed before the new solution arrives in the unit. The nurse administers a. 20% intralipids. b. 5% dextrose solution. c. 0.45% normal saline solution. d. 5% lactated Ringer's solution.

Correct answer: b Rationale: If a peripheral parenteral nutrition (PPN) formula bag empties before the next solution is available, a 5% dextrose solution (based on the amount of dextrose in the peripheral PN solution) may be administered to prevent hypoglycemia

During starvation, the order in which the body obtains substrate for energy is a. visceral protein, skeletal protein, fat, glycogen. b. glycogen, skeletal protein, fat stores, visceral protein. c. visceral protein, fat stores, glycogen, skeletal protein. d. fat stores, skeletal protein, visceral protein, glycogen.

Correct answer: b Rationale: Initially, the body selectively uses carbohydrates (e.g., glycogen) rather than fat and protein to meet metabolic needs. These carbohydrate stores, found in the liver and muscles, are minimal and may be totally depleted within 18 hours. After carbohydrate stores are depleted, skeletal protein begins to be converted to glucose for energy. Within 5 to 9 days, body fat is fully mobilized to supply much of the needed energy. In prolonged starvation, up to 97% of calories are provided by fat, and protein is conserved. Depletion of fat stores depends on the amount available, but fat stores typically are used up in 4 to 6 weeks. After fat stores are used, body or visceral proteins, including those in internal organs and plasma, can no longer be spared and rapidly decrease because they are the only remaining body source of energy available.

A complete nutritional assessment including anthropometric measurements is important for the patient who a. has a BMI of 25.5 kg/m2. b. complains of frequent nocturia. c. reports a 5-year history of constipation. d. reports an unintentional weight loss of 10 lb in 2 months.

Correct answer: d Rationale: A loss of more than 5% of usual body weight over 6 months, whether intentional or unintentional, is a critical indicator for further assessment.