NURS 321 Practice Questions for Quiz #1

A nurse is caring for a client who was prescribed 840mL of enteral nutrition to be administered via gastrostomy tube over 24hr using an infusion pump. The nurse should set the infusion pump to deliver how many mL/hr? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero)

35mL/hr

A nurse is preparing to administer total parenteral nutrition (TPN) 1800mL to infuse over 24hr. The nurse should set the IV pump to deliver how many mL/hr? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

75mL/hr

A nurse is teaching a client about nutritional requirements necessary to promote wound healing. Which of the following nutrients should the nurse include in the teaching? a. Protein b. Calcium c. Vitamin B1 d. Vitamin D

A rationale: Protein is the major structural and functional component of every cell. It is required in increased amounts during times when the body needs to heal itself and protein will promote wound healing

A nurse is instructing a group of clients about nutrition. The nurse should include that which of the following foods is a good source of high-quality protein? a. Soybeans b. Grains c. Legume d. Green vegetables

A rationale: The nurse should instruct that soybeans and soybean products are high-quality, or complete, sources of proteins. Complete proteins contain all nine essential amino acids required for growth and maintenance of the body

A nurse is providing discharge teaching to a client who will be receiving total parenteral nutrition (TPN) at home. Which of the following instructions should the nurse include? (Select all that apply) a. "Keep the TPN refrigerated when not in use" b. "Infuse 10% dextrose and water if the solution runs out" c. "Shake the TPN bag with fat emulsion is precipitate is present" d. "Stop using TPN once weight gain is achieved" e. Maintain TPN infusion rate when behind schedule"

A,B,E rationale: TPN is required by clients who have pancreatitis, ulcerative colitis, Crohn's disease, burn injury, cancer, AIDS, and starvation; E: The rate of TPN infusion should not be changed without the guidance of the provider. TPN is a hypertonic solution and should be slowly decreased in rate with a strategic plan to discontinue therapy over time. An increase or decrease in TPN infusion rate can impact the client's glucose level and cause the complication of hyperglycemia or hypoglycemia

A nurse is assessing a client who is receiving total parenteral nutrition (TPN) therapy via an infusion pump. Which of the following actions should the nurse take? a. Obtain the client's blood glucose every 12hr b. Change the IV tubing every 24hr c. Change the IV site dressing every 4 days d. Weigh the client every other day

B rationale: The nurse should change the client's IV tubing every 24hr, or per facility protocol, to prevent bacteria from developing in the tubing

A nurse is admitting a client who reports anorexia and is experiencing malnutrition. Which of the following laboratory findings should the nurse expect to be altered? a. Creatine kinase b. Troponin c. Total bilirubin d. Albumin

D rationale: A low albumin is a measure of plasma proteins which reflects the nutritional condition of a client experiencing anorexia and malnutrition over an extended period of time

A nurse is caring for a client who is receiving total parenteral nutrition and develops refeeding syndrome. The nurse should expect which of the following laboratory findings? a. Hyperglycemia b. Hyperkalemia c. Hyponatremia d. Hypophosphatemia

D rationale: The nurse should expect a low phosphate level in a client who has refeeding syndrome. Hypophosphatemia

A nurse is assessing a client who is receiving total parenteral nutrition (TPN). Which of the following findings should the nurse recognize as a complication of this therapy? a. Hyperglycemia b. Aspiration c. Diarrhea d. Stomatitis

A rationale: TPN is prescribed when extensive nutritional support for prolonged periods of time is required. It is delivered through a central venous access device, usually via the internal jugular or subclavian vein. TPN contains a high concentration of dextrose, which can result in hyperglycemia. Frequent glucose monitoring should be implemented in clients receiving TPN

A nurse is caring for a client who is receiving total parenteral nutrition via a peripherally inserted central catheter (PICC). When assessing the client, the nurse notes swelling of the clients's arm above the PICC insertion site. Which of the following actions should the nurse take first? a. Measure the circumference of both upper arms b. Notify the provider who inserted the PICC line c. Removed the PICC line d. Apply a cold pack to the client's upper arm

A rationale: The first action the nurse should take using the nursing process is to assess the client. The nurse should measure the arm and compare the result with the circumference of the other arm. If the arm is swollen, the nurse should notify the provider who inserted the PICC line. Swelling could indicate formation of a clot above the site or even catheter rupture

A nurse on the day shift is preparing to change a client's total parenteral nutrition (TPN) solution, but the new TPN solution has not arrived from the pharmacy. The client receives additional IV fat emulsion during the night shift. Which of the following actions should the nurse take? a. Hang dextrose 10% in water (D10W) until the TPN solution is delivered b. Saline lock the IV catheter after discontinuing the TPN solution c. Hang the IV fat emulsion solution d. Call the provider for new TPN orders

A rationale: The nurse should hang D10W if the TPN runs out or is not available to hang. D10W is a hypertonic solution that will maintain glucose level and prevent rebound hypoglycemia

A nurse is planning care for a client who is to start receiving total parenteral nutrition (TPN). Which of the following interventions should the nurse include in the plan of care? a. Use a 1.2 micron filter when infusing TPN with fat emulsions added b. Allow 18hr for the lipids to infuse when not mixed with the TPN solution c. Change the TPN solution after 36hr d. Change the TPN tubing every 48hr

A rationale: The nurse should use a 1.2 micron filter when infusing TPN with fat emulsion added to filter out any precipitate that is too large to pass through the filter

A nurse is planning care for a client who has decreased level of consciousness. The client is receiving continuous enteral feedings via a gastrostomy tube due to an inability to swallow. Which of the following is the priority action by the nurse? a. Observe client's respiratory status b. Elevate the head of the client's bed 30° to 45° c. Monitor intake and output every 8hr d. Check residual volume every 4 to 6hr

B rationale: A client who has a decreased level of consciousness and an inability to swallow is at risk for aspiration. Lying flat also increases this risk. The priority action by the nurse is to keep the head of the bed elevated 30° to 45° to promote gastric emptying and reduce the risk of aspiration

A nurse is prioritizing care for two clients at the start of the shift. The first client, who is 1 day postoperative following a partial bowel resection, requires a dressing change, total parenteral nutrition administration and reports a pain level of 6 on a scale from 0 to 10. The second client, who has a newly inserted percutaneous gastrostomy tube, requires a tube feeding, dressing change, and daily weight. Which of the following nursing actions should the nurse plan to complete first? a. Weigh the second client b. Obtain vital signs for both clients c. Administer pain medication to the first client d. Change the dressings of both clients

B rationale: Using the nursing process as an organizing framework, the nurse should obtain vital signs on the two clients to determine if there are any emergent problems

A nurse is assessing a client and discovers the infusion pump with the client's total parenteral nutrition (TPN) solution is not infusing. The nurse is assessing a client and discovers the infusion ump with the client's total parenteral nutrition (TPN) solution is not infusing. The nurse should monitor the client for which of the following conditions? a. Excessive thirst and urination b. Shakiness and diaphoresis c. Fever and chills d. Hypertension and crackles

B rationale: When a sudden interruption in the infusion of TPN occurs, the client is at risk for hypoglycemia. Shakiness and diaphoresis are manifestations of hypoglycemia

A nurse is teaching a client who has a prescription of a nasogastric tube (NG) to treat a pylori obstruction. Which of the following rationales for the use of the nasogastric tube should the nurse include in the teaching? a. Determine the pH of the gastric secretions b. Supply nutrients via tube feedings c. Decompress the stomach d. Administer medications

C rationale: A pyloric obstruction, also called gastric obstruction, is caused by edema, scarring, or spasm, often the result of gastritis or peptic ulcer disease. The nurse should inform the client that because the stomach is dilated and may contain undigested food, it must be decompressed, necessitating the placement of an NG tube

A nurse is caring for a client who has cancer and is receiving total parenteral nutrition (TPN). Which of the following lab values indicates the treatment is effective? a. Hct 43% b. WBC 8,000/uL c. Albumin 4.2g/dL d. Calcium 9.4mg/dL

C rationale: Clients who have cancer can receive TPN to provide needed proteins and glucose they are otherwise unable to obtain. An albumin level of 4.2g/dL is within the expected reference range and indicates the client is receiving adequate amounts of protein

A nurse is caring for a client who has Crohn's disease and is receiving parenteral nutrition. Which of the following interventions should the nurse include in the care of this client? a. Remove the parenteral nutrition solution from the refrigerator 2hr before infusion b. Remove unused parenteral nutrition after 12hr of use c. Monitor daily laboratory values and report as needed d. Monitor the flow rate of the parenteral nutrition carefully and increase the rate as need if it falls behind

C rationale: Laboratory data, as well as observation of clinical sings, are important to prevent the development of nutrient deficiencies or toxicities

A nurse is caring for a client who need to increase his protein intake. The client tells the nurse some of the food he enjoys. Which of the following foods should the nurse recommend as the best source of protein among these suggestions? a. Yams b. Eggs c. Chicken d. Peanuts

C rationale: One 3oz portion of roasted chicken breast provides about 25g of protein. This is the best source of protein among these options

A nurse prepares to replace the nearly empty container of total parenteral nutrition (TPN) for a client when she finds that there has been a delay in receiving the new container of solution from the pharmacy. Which of the following solutions should the nurse infuse until the next container of TPN solution becomes available? a. Lactated Ringer's b. 3% sodium chloride c. Dextrose 10% in water d. 0.9% sodium chloride

C rationale: Sudden withdrawal from TPN, which is a hypertonic solution that contains dextrose, vitamins, electrolytes and sometimes lipids, can result in a sudden drop in the client's blood glucose levels. Administering an infusion of 10% dextrose will prevent hypoglycemia

A nurse is preparing to administer an enteral feeding via nasogastric tube. Identify the correct sequence the nurse should follow to initiate the feeding. a. Check the residual feeding contents b. Evaluate tolerance of feeding c. Verify tube placement d. Administer the feeding

C-->A-->D-->B