Chapter 6

In addition to residual stomach volume, what other evidence suggests feeding intolerance? a. Abdominal distention b. Absence of tympany on percussion c. Active bowel sounds d. Elevated blood glucose by fingerstick

A Abdominal distention is expected if the feedings are not being absorbed. Tympany occurs along with distention.

In trauma patients, enteral nutrition via nasogastric tube feedings into the small bowel is best initiated within what time frame following the injury? a. 24 hours b. 48 hours c. 7 days d. 72 hours

A Feedings into the small bowel are frequently initiated within 24 hours after the injuryor illness.

Approximately 5 days after starting tube feedings, a patient develops extreme diarrhea. A stool specimen is collected to check for which possible cause? a. Clostridium difficile b. Escherichia coli c. Occult blood d. Ova and parasites

A Patients receiving enteral nutrition who develop diarrhea are evaluated for antibiotic- associated causes, including Clostridium difficile

Which of the following statements is true about insulin and parenteral nutrition? (Select all that apply.) a. Amount of parenteral insulin is adjusted based on the previous 24-hour laboratory values. b. Insulin may be added to a parenteral nutrition solution. c. Subcutaneous insulin is used on a sliding scale during parenteral nutrition. d. Supplemental insulin is rarely required for patients receiving parenteral nutrition.

A, B, C Hyperglycemia is common when receiving parenteral nutrition; insulin may be administered on a sliding scale for glucose control and/or added to the parenteral solution. Amount of insulin added to the parenteral solution is calculated based on the previous 24-hour laboratory values

Which statement(s) about total parenteral nutrition is (are) true? (Select all that apply.) a. Assessing fluid volume status and preventing infection are important nursing considerations. b. Fingerstick glucose levels are assessed every 6 hours and prn. c. Total parenteral nutrition is administered through a feeding tube and pump. d. Total parenteral nutrition, with added lipids, provides adequate levels of protein, carbohydrates, and fats.

A, B, D All are correct except administration via a feeding tube and pump. A tube and pump are used to deliver enteral nutrition

Calorie-dense feedings: (Select all that apply.) a. are most useful in heart failure and liver disease. b. are most useful in malabsorption syndromes. c. contain 2 kcal/mL and 70 g protein/L. d. include increased fiber.

A, C Calorie-dense feedings are used when volume should be minimized and protein requirements are high, such as in heart failure or liver disease. They contain 2 kcal/mL and 70 g protein/L.

A patient with a history of emphysema, diabetes, and hyperlipidemia is in the critical care unit on a ventilator. The nutrition assessment notes that the patient has a protein and vitamin deficiency and is underweight. Which formula for nutritional assessment is most appropriate? a. Elemental protein formula b. Fiber-added formula c. High medium-chain triglyceride formula d. Lactose-free formula

B Added fiber helps control blood glucose and reduce hyperlipidemia.

A patient is having complications from abdominal surgery and remains NPO. Because enteral tube feedings are not possible, the decision is to initiate parenteral feedings. What are the major complications for this therapy? a. Aspiration pneumonia and sepsis b. Fluid and electrolyte imbalances and sepsis c. Fluid overload and pulmonary edema d. Hypoglycemia and renal insufficiency

B Because of the high dextrose concentration, including the fluid and electrolyte content, the patient is placed at high risk for sepsis and fluid and electrolyte imbalances. Aspiration pneumonia is a potential complication of enteral feedings; sepsis is a potential complication of parenteral nutrition. Fluid overload is possible but unlikely and is not a major complication of parenteral nutrition. Hyperglycemia is more of a concern than hypoglycemia with parenteral nutrition; however, renal insufficiency is not related to parenteral nutrition.

The best nursing approach to prevent feeding tube obstruction is: a. dilute the feeding to make it flow more easily. b. flush the tube every 4 hours with 20 to 30 mL of tap water. c. pass a stylet daily to keep the tubing clear. d. use a larger bore tube where possible.

B Flushing the tubing every 4 hours helps prevent obstruction. Diluting tube feedings can cause water intoxication. Stylets are never used to clear a tube, and the smallest bore possible should be used for best tolerance.

Malnutrition contributes to infection risk by: a. hampering normal gastrointestinal motility. b. impairing immune function. c. increasing blood glucose. d. increasing drug interactions.

B Malnutrition impairs immune function.

A patient with acute pancreatitis is started on parenteral nutrition. The student nurse listed possible interventions for this patient. Which intervention needs correction before finalizing the plan of care? a. Change the intravenous tubing every 24 hours. b. Infuse antibiotics through the intravenous line. c. Monitor the blood glucose every 6 hours. d. Monitor the fluid and electrolyte balance.

B Medications should not be infused through the IV line infusing parenteral nutrition.

The nurse identifies which patient at greatest risk for malabsorption of protein? a. The patient with gallbladder obstruction b. The patient with ileitis c. The patient with distal colon resection d. The patient with jejunal tumor

B The ileum is where protein is broken down and absorbed; the patient with ileitis would be at greatest risk for protein malabsorption

Risks of total parenteral nutrition include: (Select all that apply.) a. diarrhea. b. elevated blood sugar. c. infection at the catheter site. d. volume overload.

B, C, D Diarrhea is more common with enteral tube feedings; the other risks are common with total parenteral nutrition.

Which intervention(s) is (are) critical during intravenous lipid administration? (Select all that apply). a. Assess glucose levels. b. Change the tubing every 24 hours. c. Hold lipids when administering antibiotics through the same line. d. Monitor triglyceride levels.

B, D Lipids are very good media for bacterial growth; lipid tubing should be changed every 24 hours. Triglyceride levels must be monitored until stable when administering lipids.

The correct order of actions for a patient starting enteral nutrition with a feeding tube is: _______________, _______________, _______________, _______________, _______________. (Put a comma and space between each answer choice.) A. Initiate tube feeding. B. Insert feeding tube. C. Flush tube to verify patency. D. Obtain chest radiograph. E. Assess residuals.

B, D, C, A, E Initially the feeding tube will be inserted and final placement verified via chest radiograph. The next step is to flush the feeding tube and start the tube feedings. Residuals are checked every 4 hours.

A patient has been admitted to the critical care unit after a stroke. After "failing" a swallow study, the patient is placed on enteral feedings. Following placement of a nasogastric tube for tube feeding, what is the next critical step? a. Administer medications. b. Cap off and wait 24 hours before starting feedings. c. Obtain a chest radiograph. d. Start the tube feeding.

C Correct placement must be verified by radiograph before use of the tube.

An important nutritional consideration in the elderly population is: a. decreased protein requirements. b. increasing caloric requirements with age. c. potential for drug-nutrient interaction related to polypharmacy. d. presence of other diseases that decrease caloric needs.

C Patients taking multiple medications have a greater potential for drug-nutrient interactions; elderly persons may be taking multiple medications.

In evaluating a patient's nutrition, the nurse would monitor which blood test as the most sensitive indicator of protein synthesis and catabolism? a. Albumin b. BUN c. Prealbumin d. Triglycerides

C Prealbumin is the most sensitive indicator of protein synthesis and catabolism.

Patients experiencing severe physiological stress increase their nutritional requirements to: a. 20 kcal/kg/day. b. 30 kcal/kg/day. c. 35 kcal/kg/day. d. 50 kcal/kg/day.

C Severely stressed individuals require 35 kcal/kg/day; 50 kcal/kg/day exceeds caloric needs. A total of 20 kcal/kg/day is less than normal caloric requirements. A total of 30 kcal/kg/day is the caloric requirement for a moderately stressed individual.

A patient is being fed through a nasogastric tube placed in his stomach. The nurse would carry out which intervention to minimize aspiration risk? a. Add blue dye to the formula. b. Assess the residual every hour. c. Elevate the head of the bed 30 degrees. d. Provide feedings via continuous infusion.

C The head of the bed should be kept elevated at least 30 degrees if possible during tube feedings to minimize reflux. Blue dye should not be used. Neither continuous feedings nor checking for residual will minimize aspiration.

A patient's feeding tube has been successfully placed in the small intestine with continuous flow tube feeding. The nurse knows that this approach was chosen because: a. intermittent feedings cause increased nausea and vomiting. b. the increased filling of the stomach increases absorption. c. the intestinal mucosa normally receives nutrients from the stomach in peristaltic waves. d. this will prevent malabsorption syndrome.

C The small intestine usually receives nutrients from the stomach in peristaltic waves; this simulates normal peristalsis.

A patient is receiving enteral tube feedings and has developed drug-nutrient interactions. The nurse recognizes which drug as having the potential for causing drug-nutrient reactions? a. Aspirin b. Enoxaparin c. Ibuprofen d. Phenytoin

D Bioavailability of phenytoin is reduced when administered with enteral feedings.

Select the physiological reasoning behind enteral therapy as the preferred source of nutritional therapy. a. Gut overgrowth increases. b. Gastroparesis increases. c. Bacterial translocation is initiated. d. Gut mucosa is preserved.

D Enteral feedings prevent bacterial overgrowth and potential bacterial translocation from the gastrointestinal tract and preserve the gut mucosa.

Which statement is true about normal function of the gastrointestinal (GI) tract? a. Failure of the tight junctions allows bacteria to invade the GI tract. b. The gut lacks protective mechanisms; thus, infection is always a concern. c. Water is reabsorbed at the beginning of the colon. d. Without nutritional stimulation, mucosal villi atrophy.

D Mucosal villi replenish every 3 to 4 days; without nutritional stimulation, they atrophy.

A patient who is receiving continuous enteral feedings has just vomited 250 mL of milky green fluid. This is a concern because this most likely demonstrates that the patient has: a. a bowel obstruction. b. developed an ileus. c. gastrointestinal bleeding. d. tube feeding intolerance.

D Nausea and vomiting are signs of tube feeding intolerance.

A patient is being ventilated and has been started on enteral feedings with a nasogastric small-bore feeding tube. What is the primary reason the nurse must frequently assess tube placement? a. To assess for paralytic ileus b. To maintain the patency of the feeding tube c. To monitor for skin breakdown on the nose d. To prevent aspiration of the feedings

D Patients who are on a ventilator and who are receiving tube feedings are at a high risk for aspiration and ventilator-associated pneumonia. Assessment of tube placement will neither determine presence of paralytic ileus nor maintain patency. Assessment of tube placement is performed to minimize aspiration risk, not skin breakdown on the nose.

A patient, who has a tube feeding, requires a chest x-ray study for evaluation of a cough. To reduce the risk of aspiration, the nurse: a. helps the radiology technician to position the patient to avoid dislodging the tube. b. holds feedings until placement has been verified. c. slows the infusion rate by half. d. stops feedings 10 to 15 minutes before placing flat to obtain the radiograph.

D Temporarily stopping feedings when flat minimizes the risk of aspiration if the patient will be supine.

A patient is receiving enteral feedings and has just vomited 250 mL of milky green liquid. The nurse holds the tube feeding, which had been infusing at 100 mL/hr. The nurse knows that the next action should be: a. connect the feeding tube to suction. b. continue the tube feeding. c. decrease the tube feeding. d. recheck the residual in 2 hours.

D The patient is not tolerating the tube feeding. It should be held until he has absorbed the remaining tube feeding. Feedings may resume when residuals are less than 250 mL.

The patient is to start parenteral nutrition. The nurse knows to prepare which site for catheter insertion? a. Basilic vein b. Femoral vein c. Radial artery d. Subclavian vein

D Total parenteral nutrition is administered through a central intravenous line, such as the subclavian vein. Arteries are never used. The femoral site is avoided. The basilic vein is not a central site.

Objective data designating that the nutrition goals are not being met include: a. hyperglycemia, normovolemia, and increased protein level. b. overhydration, hypoglycemia, and weight gain. c. weight gain, inconsistent glucose, and normovolemia. d. weight loss, elevated glucose, and dehydration.

D When nutritional goals are not being met, the patient experiences weight loss, elevated glucose levels, and either overhydration or dehydration.