Lewis 39: Nutritional Problems

adbc

Facilitating the nutritional status of a patient early in the starvation cycle is important. The nurse recalls that the events that lead to starvation occur in what order? a. Carbohydrate stores are depleted. Incorrect b. The body mobilizes fat to supply energy. Incorrect c. The body uses visceral or body proteins as the source of energy. Incorrect d. The body converts skeletal proteins to glucose for energy.

c

A patient presents to a clinic with bleeding gums, loose teeth, and dry, itchy skin. The patient states, "I have very little money, but I make sure that my children are fed. Sometimes it means that I don't have much to eat." The nurse suspects that the patient is lacking which vitamin?

b

A patient receives a prescription for central parenteral nutrition (PN) therapy. Which principle should guide the nurse's administration of the patient's nutrition? a. Central PN is indicated when protein and caloric requirements are not high. b. Central PN must be infused in a large central vein so rapid dilution can occur. c. The solution is hypotonic, so infusion rates should be adjusted accordingly. d. The glucose content ranges from 10% to 15%.

b

A patient underwent a below-the-knee amputation surgery and is ready for discharge. Which foods would the nurse recommend to improve tissue repair and maintenance? a. Cooked fruits b. Lean poultry c. Raw vegetables d. White rice

abc

A nurse is advising a patient to include complex carbohydrates in the diet. Which food items contain complex carbohydrates? Select all that apply. a. Cereals b. Potatoes c. Legumes d. Milk e. Table sugar

ab

A patient has undergone a jejunostomy. The patient is receiving feedings through an orogastric tube. The nurse recognizes that the patient is at risk for what conditions? Select all that apply. a. Skin irritation b. Dislodgment of the tube c. Fluid retention and electrolyte imbalances d. Dry and scaly skin, brittle nails, rashes, and hair loss e. Impaired absorption of nutrients from the gastrointestinal (GI) tract

protein

A patient is diagnosed with malnutrition. On assessment, the nurse finds that the patient has edema on the face and legs. What depletion is the probable reason for the edema?

d

A patient is hospitalized with malnutrition. The nurse recalls that what laboratory result is associated with disease-related malnutrition with inflammation? a. Decreased glucose turnover b. Decreased nitrogen excretion c. Decreased basic metabolic rate d. Increased C-reactive protein (CRP)

b

A patient is receiving an initial infusion of parenteral nutrition (PN). What is a priority nursing assessment? a. Skin integrity and bowel sounds b. Electrolyte levels and daily weights c. Auscultation of the chest and tests of blood coagulability d. Peripheral vascular assessment and level of consciousness (LOC)

d

A patient is receiving enteral nutrition through a nasogastric tube. What measure should the nurse take to reduce the risk of aspiration? a. Using a high-fiber formula b. Labeling or color-coding feeding tubes and connectors c. Marking the exit site of the feeding tube d. Elevating the head of bed to 45 degrees

cde

A patient is receiving parenteral nutrition. The nurse should monitor the patient for what metabolic complications? Select all that apply. a. Phlebitis b. Dislodgment c. Hypoglycemia d. Hyperglycemia e. Hyperlipidemia

protein

A patient is scheduled for abdominal surgery for diagnostic exploration of unexplained abdominal pain. The nurse should instruct the patient to follow a diet high in what during the weeks prior to the surgery?

a

A patient who is malnourished is being administered an intravenous fat emulsion. The nurse's assessment findings include an elevated body temperature, increased triglyceride levels, and a decreased respiratory rate. Which action should the nurse take? a. Discontinue the emulsion. b. Slow the rate of the emulsion administration. c. Change the infusion to parenteral nutrition. d. Document the findings and continue the infusion.

c

A patient who is receiving parenteral nutrition reports burning and prickling sensations. The nurse suspects that the paresthesias are related to what? a. Distention of the abdomen b. Displacement of a catheter c. Presence of refeeding syndrome d. Reduction in serum levels of fat-soluble vitamins

b

A patient will begin receiving peripheral parenteral nutrition (PPN). The nurse should question which part of the PPN prescription? a. The solution contains amino acids. b. The solution measures 1700 mOsm/L. c. The solution is to infuse at 100 mL/hour. d. The solution contains 30 mEq of potassium chloride.

bce

A patient with a history of parenteral nutrition (PN) therapy develops a complication associated with the therapy, including hypophosphatemia. The nurse should monitor the patient closely for which outcomes? Select all that apply. a. Diarrhea b. Paresthesias c. Respiratory arrest d. Nausea and vomiting e. Cardiac dysrhythmias

b

A patient with severe trauma is scheduled for surgery. The nurse identifies that the patient will require which nutritional components to promote wound healing? a. Carbohydrates and proteins b. Proteins and calories c. Vitamins and minerals d. Carbohydrates and calories

ac

A stable patient is receiving enteral feeding through a gastrostomy tube. Which care could the registered nurse (RN) delegate to a licensed practical/vocational nurse (LPN/LVN)? Select all that apply. a. Administer bolus or continuous feedings b. Evaluate the nutritional status of the patient c. Administer medications through the gastrostomy tube d. Monitor for complications related to the tube and enteral feeding e. Teach the caregiver about feeding via the gastrostomy tube at home

d

The nurse finds that a patient receiving tube feedings has developed diarrhea. What is an appropriate treatment plan? a. Increase the rate of the feedings. b. Change to a formula with less fiber. c. Maintain unused formula at room temperature. d. Discontinue excess water boluses.

abc

The nurse identifies that enteral nutrition (EN) is indicated for which types of patients? Select all that apply. a. A patient with extensive burns b. A patient who has a functioning GI tract but is unable to take any oral nourishment c. A patient with orofacial fractures d. A patient with GI obstruction e. A patient with short bowel syndrome

dacb

The nurse is caring for a 47-yr-old female patient who is comatose and is receiving continuous enteral nutrition through a soft nasogastric tube. The nurse notes the presence of new crackles in the patient's lungs. In which order will the nurse take action? a. Check the patient's oxygen saturation. b. Notify the patient's health care provider. c. Measure the tube feeding residual volume. d. Stop administering the continuous feeding.

abce

The nurse is caring for a patient who is suspected to be malnourished. Which components should the nurse assess while performing a nutritional screening of this patient? Select all that apply. a. Handgrip strength b. Diet history c. Depression d. Serum albumin level e. Rate of weight change f. White blood cell (WBC) count

hyperlipidemia

The nurse is caring for a patient with burn injuries who is also malnourished. The nurse notes that the patient's intravenous fat emulsion was recently discontinued. The nurse suspects that the action was taken because the patient is experiencing what condition?

bcd

The nurse is caring for an underweight patient and should recommend which food items? Select all that apply. a. Salads b. Eggs c. Nuts d. Legumes e. Skim milk

abe

The nurse is helping a patient select food for a healthy lifestyle. What instructions should the nurse give to this patient? Select all that apply. a. Eat more whole grains. b. Avoid oversized portions. c. Drink more fruit juices. d. Sodium intake should come from foods such as cured meats rather than from table salt. e. Add fruit to meals as part of main or side dishes.

prealbumin

The nurse is reviewing diagnostic study results for a patient with suspected malnutrition. When compared to other lab studies, which diagnostic test is considered to be the best indicator of current nutritional status?

bde

The nurse plans care for patients with nasogastric and gastric tubes and enteral feedings in place. Which interventions can be delegated to unlicensed assistive personnel (UAP)? Select all that apply. a. Removing a nasogastric tube b. Emptying drainage devices and measuring output c. Irrigating nasogastric and gastrostomy tubes d. Weighing a patient who is receiving enteral feeding e. Providing oral care to patients who have a nasogastric, gastrostomy, or jejunostomy tube

abe

The nurse provides care for a patient with suspected malnutrition. Which assessment data is used for diagnosing malnutrition? Select all that apply. a. Vital signs b. Diet history c. X-ray studies d. Capnography e. Body mass index

abde

The nurse provides care for patients on a medical surgical unit. Which patients are likely candidates for parenteral nutrition? Select all that apply. a. A patient with a gastrointestinal (GI) obstruction b. A patient experiencing intractable diarrhea c. A patient diagnosed with megaloblastic anemia d. A patient with severe anorexia nervosa e. A patient that had a complicated surgery

c

The nurse provides information about foods high in iron to a patient who has iron deficiency. The nurse recognizes that the teaching has been effective when the patient chooses what food item as the best source of iron? a. Two eggs b. Two slices of whole wheat bread c. One cup of cooked soybeans d. One cup of peanuts

abe

The nurse recognizes that parenteral nutrition (PN) may be the only feasible option for patients with what conditions? Select all that apply. a. Nonfunctioning GI tract b. GI obstruction c. Head cancer d. Facial swelling e. Short bowel syndrome

c

The nurse reviews the medication history of a patient experiencing dry and scaly lips, brittle nails, and mouth crusting. The nurse suspects that the patient is malnourished. Which type of medication in the patient's history supports the nurse's conclusion? a. Diuretics b. Laxatives c. Corticosteroids d. Antidepressants

skeletal protein

The nurse reviews the pathophysiology of starvation. When carbohydrate (glycogen) stores are depleted, what does the body convert to glucose for energy?

cde

What are contraindications of enteral nutrition? Select all that apply. a. Burns b. Hyperlipidemia c. Ileus d. Peritonitis e. Intestinal obstruction

ace

What dietary changes are appropriate for the nurse to implement for older adults with malnutrition? Select all that apply. a. Give a vitamin D supplement daily. b. Provide nutritional supplements as meal substitutes. c. Provide parenteral nutrition when required. d. Provide moderate amounts of low-protein foods at each meal. e. Use oral liquid supplements instead of water with oral medications.

b

What is an expected assessment finding for a patient who has a vitamin C deficiency? a. Osteomalacia b. Poor wound healing c. Neurological deficits d. Parasthesias

d

Which component of nutritional assessment includes determining a patient's body mass index, height, weight, and amount of weight loss? a. Health history b. Functional status c. Physical examination d. Anthropometric measurements

bce

Which diagnostic finding in the laboratory reports supports the nurse's suspicion that a patient with burn injuries is experiencing malnutrition? Select all that apply. a. Increased creatinine b. Decreased transferrin c. Increased liver enzymes d. Increased serum albumin e. Decreased blood urea nitrogen

ae

Which laboratory findings indicate malnutrition? Select all that apply. a. Elevated potassium levels b. Elevated lymphocyte count c. Decreased levels of liver enzymes d. Elevated levels of water-soluble vitamins e. Decreased serum levels of fat-soluble vitamins

abd

Which of the nurse's assigned patients should be referred to the dietitian for a complete nutritional assessment (select all that apply)? a. A 48-yr-old patient with rheumatoid arthritis who takes prednisone daily b. A 23-yr-old patient who has a history of fluctuating weight gains and losses c. A 35-yr-old patient who complains of intermittent nausea for the past 2 days d. A 64-yr-old patient who is admitted for débridement of an infected surgical wound e. A 52-yr-old patient admitted with chest pain and possible myocardial infarction (MI)

b

Which tube feeding reduces the risk of aspiration in patients with chronic reflux? a. Gastrostomy b. Jejunostomy c. Orogastric tubing d. Nasogastric tubing