NUTRITION & BOWEL ELIMINATION

A nurse is caring for a client who is prescribed intermittent enteral nutrition via a nasogastric tube.​ When preparing to administer formula from a prefilled bag, which actions taken by the nurse are most appropriate? Select all that apply. A. Assess the client's aspiration risk.​ B. Ensure the formula solution is below 50°F. C. Elevate the head of the bed to 15 degrees.​ D. Verify proper tube placement. ​

A & D

A nurse is caring for a client who is prescribed fat emulsion (lipids) as part of total parenteral nutrition therapy. Which statements best describe fat emulsions? Select all that apply. ​ A. Use a dedicated central line lumen for the fat emulsion solution. ​ B. Verify client allergies before administration. C. Contraindicated if severe hyperlipidemia. ​ D. Ensure that the fat emulsion solution appears white and opaque.​ E. Change the administration tubing every 24 hours. ​

A, B , C & D

The nurse is caring for a client who is newly diagnosed with diabetes mellitus type 1 and is providing nutrition education. Which information should the nurse include? Select all that apply. A. Saturated fat intake should be limited to less than 7% of daily caloric intake. B. Sodium may be consumed as desired, since it does not impact blood glucose. C. Carbohydrate counting can be used to determine the correct dose of insulin. D. Complex carbohydrates are better than simple carbohydrates to maintain stable glucose. E. Artificial sweeteners must be avoided.

A , C & D

The nurse is caring for a client and suspects dysphagia. Which are the general symptoms of aspiration? A. Drop in oxygen saturation while eating B. Wheezing breath sounds C. Coughing or choking while drinking D. Pocketing food E. Epigastric pain within 60 minutes of eating

A, B, C & D

A nurse is caring for a toddler with cerebral palsy who has limited communication and impaired mobility of the lips and tongue. Which instructions should be provided to the toddler's caregiver? Select all that apply. A. Assure correct positioning when feeding. B. Monitor weight daily to ensure adequate intake. C. Thicken liquids to prescribed consistency. D. Instruct that drooling and gagging are expected. E. Provide small, easy to swallow bites.

A, B, C & E

The nurse is caring for a client with ulcerative colitis who has had severe diarrhea for more than 7 days.​ Blood in the stool is suspected. Which diagnostic test should the nurse perform? ​ A. Complete blood count B. Colonoscopy C. Guaiac fecal occult blood test​ D. Sigmoidoscopy​

C

A nurse is preparing to assist a client with oral nutrient intake. Which action is the priority?​ A. Assist the client to a chair or raise the head of the bed 90 degrees.​ B. Assess for aspiration risk. ​ C. Instruct the client to tuck the chin to the chest when swallowing.​ D. Clear clutter from the overbed table. ​

B

A nurse is caring for a client admitted with left-sided weakness and facial drooping for 3 days. Which nursing actions will protect the client's airway while eating and drinking? Select all that apply. A. Do not provide a straw for drinking. B. Avoid talking to the client while they are eating. C. Withhold fluids until food is consumed. D. Position the client left-side lying after eating. E. Encourage the client to take large bites. F. Position the client upright when eating.

A, B & F

Which medication may cause constipation? A. Opioid analgesics B. Antibiotics C. Laxatives D. Non-steroidal anti-inflammatories​

A

The nurse is caring for a client with Crohn's disease who is prescribed a low-fiber diet. Which foods may be included on the meal tray? Select all that apply. A. Soft fruit without peel B. Soft cooked eggs C. Whole grain toast D. Oatmeal E. Whole apple

A & B

A nurse is caring for a client who has just finished eating. While talking to the nurse, the client's voice sounds "wet" and gurgling. Which action should the nurse take first? A. Place the client on nothing by mouth (NPO) status. B. Contact the healthcare provider. C. Document the amount of food consumed. D. Ask the client to clear their throat and take small sips of water, then reassess​

A

The nurse begins to advance the nasogastric tube and is continuously monitoring the client's oxygen saturation. Suddenly, the client begins to cough and oxygen saturation drops from 95% to 91%. What is the priority action by the nurse?​ A. Stop the procedure and withdraw the tube into the posterior nasopharynx. ​ B. Ask the client to take sips of water while slowly advancing the tube C. Have the client take a deep breath and quickly advance the tube into position. ​ D. Insert past the resistance and confirm placement before use. ​

A

The nurse is caring for a client who is newly diagnosed with diabetes mellitus type 1. Which therapeutic diet should the nurse recommend? A. Consistent carbohydrate diet B. Low-fiber diet C. ​Gluten-free diet​ D. Vegetarian diet

A

The nurse is caring for a client with hypertension. Which nutrient should be restricted in the diet? A. Sodium B. Calcium C. Fiber D. Potassium

A

The nurse is inserting a nasogastric tube for a client who is unconscious. In which position should the nurse place the client?​ A. Reverse Trendelenburg​ B. Right side-lying​ C. Sim's position​ D. Left side-lying​

A

This is caring for a client who had major abdominal surgery 2 days ago. Which nutrient is most important to recommend to the client to promote healing? A. Protein B. Zinc C. Vitamin A D. Vitamin C

A

The nurse is caring for a client who has significant nonmodifiable risk factors for coronary artery disease. When providing nutritional education, which information should the nurse include? Select all that apply. A. Eat foods that are low in saturated fat. B. Decrease fiber intake. C. Decrease consumption of red meat. D. Eat fish several times weekly. E. Limit sodium to about 2 grams daily.

A, C, D & E

The nurse is caring for a client who has been prescribed a low-sodium diet. Which items can the client order for dinner? Select all that apply. A. Quinoa with butternut squash B. Steamed vegetables C. Mix of berries D. Chicken broth E. Hamburger with french fries

A, B & C

The nurse is caring for a client who is newly diagnosed with diabetes mellitus type 1. When educating the client about carbohydrate counting, which information should the nurse include? Select all that apply. A. Complex carbohydrates are better at maintaining a stable blood glucose. B. Carbohydrate counting is used to manage food intake and insulin administration. C. Total carbohydrate grams found in a food can be located on the nutrition label. D. The more carbohydrates consumed, the less insulin that is needed. E. The types of carbohydrates determine the amount of insulin needed.

A, B & C

The nurse is caring for a client who is prescribed a clear liquid diet. Which items can the client order for breakfast? Select all that apply. A. Apple juice B. Warm tea C. Grape gelatin D. Coffee with creamer E. Cream of wheat cereal F. Custard

A, B & C

​What actions should the nurse take prior to insertion? Select all that apply. ​ A. Assess the client's respiratory status.​ B. Verify the healthcare provider order.​ C. Discuss the client's previous experience with nasogastric tubes.​ D. Request a swallow study.​ E. Administer an antacid to increase peristalsis.

A, B & C

What are the contraindications for the insertion of a nasogastric tube? Select all that apply. A. Basilar skull fracture​ B. Deviated nasal septum​ C. Malnutrition ​ D. Anticoagulant therapy​ E. Gastroesophageal reflux disease​

A, B & D

A nurse is administering an enteral feeding to a client via a nasogastric tube. Which nursing interventions are most appropriate? Select all that apply. ​ A. Administer the feeding at room temperature.​ B. Verify feeding tube placement.​ C. Elevate the head of the bed 20 degrees. D. Use sterile techniques to connect administration tubing to the feeding container.​ E. Flush the feeding tube with 30 mL water.​

A, B & E

A nurse is caring for several clients at risk for aspiration. Which information should the nurse consider when planning care? Select all that apply. A. Aspiration can be silent without common symptoms. B. Aspiration means that food or water enters the trachea instead of the stomach. C. All older adults are at risk for aspiration. D. Only clients with dysphagia are at risk for aspiration. E. The body is not functioning properly when aspiration occurs.

A, B & E

The nurse is caring for several clients who have recently given birth. Which statements are accurate about nutrition while breastfeeding? Select all that apply. A. Vitamins A, B, and C are essential needed nutrients while breastfeeding. B. Alcohol should be avoided as it is excreted in breast milk. C. Protein requirements decrease during lactation. D. Caffeine can be readily consumed as it is not excreted in breast milk. E. Lactation requires a 500 kcal/day caloric increase to support milk production.

A, B & E

A nurse is caring for a client who is being discharged. While discussing the importance of nutrition for healing, the client states that they do not have enough money to buy fresh fruits, vegetables, and quality protein. Which statements by the nurse are most helpful? Select all that apply. A. "Frozen fruits and vegetables are quick, easy, and inexpensive options." B. "Canned vegetables provide necessary nutrients and are more affordable." C. "Fresh fruits and vegetables are the only way to get the nutrients necessary for healing." D. "I will have the social worker provide information on local community resources for food." E. "You may be eligible for several governmental assistance programs for food."

A, B, D & E

Many observable signs indicate a client's nutritional status. What are physical signs of impaired nutrition? Select all that apply. A. Anorexia B. Obesity C. Body mass index (BMI) 22 D. Dull, brittle, dry hair E. Easily fatigued with no energy F. Regular bowel habits G. Soft abdomen

A, B, D & E

Which are important components of a nutrition assessment? Select all that apply. A. Assess the client's medical history for gastrointestinal (GI) tract abnormalities. B. Assess for physical signs of malnutrition. C. Request a swallow study be completed by a speech therapist. D. Ask the client about eating habits. E. Calculate a baseline body mass index (BMI).

A, B, D & E

The nurse is caring for a client with an increased risk for aspiration. Which actions should the nurse take? Select all that apply. ​ A. Maintain an upright position for at least 30 minutes after a meal. ​ B. Monitor oxygen saturation during feeding. C. Tilt the head backward when swallowing liquid. ​ D. Position the client upright (45-90 degrees) during feedings. ​ E. Avoid mixing foods of different textures in the same mouthful. ​

A, B, D, & E

A nurse is caring for a client receiving intermittent enteral nutrition who is at risk for aspiration due to delayed gastric emptying. Which actions should the nurse take to prevent pulmonary aspiration? Select all that apply. A. Maintain suctioning equipment at the bedside.​ B. Elevate the head of the bed 45 degrees during and following feedings. ​ C. If the client starts coughing or becomes dyspneic, slow the rate of the feeding. D. Administer oral medications to promote peristalsis.​ E. Verify tube placement prior to feeding. ​ F. Check gastric residuals before each feeding. ​

A, B, D, E & F

A nurse is caring for a client with Parkinson's disease who is not prescribed aspiration precautions. The client appears to have no difficulties with eating or drinking. Why might the nurse remain concerned about aspiration risk? SELECT ALL THAT APPLY. A. Silent aspiration is common with neurologic disorders. B. The client may be hiding the difficulty with swallowing. C. Some aspiration may be occurring even without obvious signs. D. Clients with Parkinson's disease always have dysphagia. E. Decreased sensation can cause silent aspiration.

A, C & E

During administration, the client begins to experience abdominal cramping and nausea. Which actions should the nurse take? Select all that apply. ​ A. Request medication to promote peristalsis. ​ B. Discontinue the feeding immediately and contact the healthcare provider.​ C. Slow the rate of the feeding infusion. ​ D. Place the client in a side-lying position and continue the administration. ​ E. Raise the head of the bed to 90 degrees. ​

A, C & E

The nurse is caring for a client who is prescribed a full liquid diet. Which items can the client order for lunch? Select all that apply. A. Vanilla ice cream B. Sliced banana with strawberries C. ​Carbonated water ​ D. Steamed soft vegetables E. Cream of potato soup

A, C & E

The nurse is caring for an older adult client. What are the physical signs of malnutrition? Select all that apply. A. Receding gums B. Facial flushing C. Peripheral edema D. Yellowing teeth E. Oral lesions

A, C & E

A nurse is caring for an older adult client who is losing weight. What may be contributing to this problem? Select all that apply. A. Fad dieting B. Decreased metabolism C. Alterations in taste and smell​ D. Chronic illness E. Food insecurity

A, C, D & E

The nurse is caring for a 77-year-old client who is being discharged. As part of discharge planning, what will the nurse include in the teaching? Select all that apply. A. Strategies to address changes in taste and smell B. Instructions regarding foods which decrease metabolism C. Foods that are low in fiber D. Need to schedule regular oral health exams E. Importance of adequate hydration

A, D & E

The nurse is caring for several infants. Which statements are accurate about infant nutrition? Select all that apply. A. Complementary foods should be started at age six months while breastfeeding continues. B. Infants should have new foods introduced daily beginning at six months of age. C. Commercial formula and human breast milk both provide 40 kcal/ounce. D. It is recommended that infants be exclusively breastfed for the first six months of life. E. A healthy infant needs approximately 100 kcal/kilogram of body weight daily.

A, D & E

The nurse is caring for a client with human immunodeficiency virus (HIV). Which dietary restrictions should the nurse anticipate? Select all that apply. A. Whole fruits with edible skin B. Protein C. Calories D. Sushi E. Fluids F. Raw vegetables

A, D & F

The nurse is making care assignments for several clients. Which clients may have difficulty swallowing and require aspiration precautions? Select all that apply. A. A client who had a stroke B. A client with Crohn's disease C. A client with a mitral valve prolapse D. A client with muscular dystrophy E. A client with Parkinson's disease F. An adolescent client who had surgical removal of traumatized tissue in the neck

A, D , E & F

A nurse is admitting a client with gastrointestinal concerns. Which factors must be considered when completing a diet and health history? Select all that apply.​ A. Diet preferences B. Socioeconomic status C. Religious requirements D. Food allergies E. Cultural background

ALL OF THE ABOVE

A few days later, the nurse receives a prescription to remove the nasogastric tube. Which instruction should the nurse provide to the client about tube removal? A. Take a deep breath while the nurse removes the tube quickly during inspiration. ​ B. Take a deep breath and hold it while the nurse kinks the end of the tube and steadily removes it. ​ C. Cough while the nurse simultaneously removes the tube.

B

A nurse is caring for a client with prescribed aspiration precautions. What is the main concern when a client has pockets of food remaining in the mouth after eating? A. The pocket of food may not have been chewed up properly. B. Eventually, the pocket of food may be aspirated into the airway. C. The food left in the mouth will make speech and communication difficult. D. Pocketing is a sign of drowsiness or disorientation.

B

It is now time for the next intermittent feeding and the nurse is preparing to check gastric residual. Which action is most appropriate? A. Contact the healthcare provider if more than 100 mL of residual is present.​ B. Use a large syringe to aspirate gastric contents from the tube. C. Discard contents after aspiration. ​ D. Check gastric residual once every 24 hours. ​

B

The nurse is caring for a client who observes Hindu dietary practices and has requested diet accommodations that reflect their practice. What should the dietary department be notified of? A. Avoid pork. B. Avoid all meats and some fish. C. Ensure that dairy products are not mixed with meat dishes. D. Adhere to kosher food preparation methods.

B

The nurse is caring for a client with ulcerative colitis who has had severe diarrhea for more than 7 days.​ Further testing reveals that the client has a Clostridium difficile (C. diff) infection. The client asks how the infection was acquired. Which response by the nurse is most accurate? A. C. diff is spread via respiratory droplets during coughing.​ B. C. diff is commonly caused by antibiotic therapy. ​ C. C. diff is uncommon and often of unknown origin. D. C. diff is a sexually transmitted infection. ​

B

The nurse is caring for an older adult client recovering from left knee replacement surgery four days ago who is concerned that they have not had a bowel movement since before surgery. The client reports feeling bloated and nauseous. The nurse notes that the client did not have breakfast, and had very little lunch today. ​ Upon assessment, the nurse notes hypoactive bowel sounds in all four quadrants, and the abdomen is tender and distended. Which bowel elimination problem does the nurse suspect? A. Flatulence ​ B. Constipation​ C. Fecal impaction ​ D. Diarrhea​

B

The nurse measures the length of the nasogastric tube and notes the desired length. The tube is inserted gently through the nostril to the back of the throat, aiming back and toward the ear. The nurse then has the client take a deep breath, relax, and flex the head toward the chest after the tube has passed the nasopharynx. Which step is next in the insertion process? A. Have the client look up at the ceiling as the tube is advanced.​ B. Ask the client to take small sips of water and swallow as the tube is advanced. ​ C. Gently rotate the tube 90 degrees while advancing. ​ D. Secure the tube to the nostril and request a chest x-ray. ​

B

Prior to formula administration, the nurse plans to verify placement of the tube. Which are correct methods of tube placement verification? Select all that apply. ​ A. Auscultating the lungs for adventitious sounds​ B. Aspiration of gastrointestinal contents and measuring pH levels​ C. Injecting air into the tube while auscultating the stomach​ D. Requesting an x-ray image of the client's chest and abdomen​ E. Auscultating bowel sounds in all four quadrants​

B & D

The nurse is caring for a client with celiac disease who has been prescribed a gluten-free diet. Which foods must be excluded from the meal tray? Select all that apply. A. White rice B. Oatmeal C. Apple juice D. White pasta E. Whole wheat bread

B & E

When removing the nasogastric tube, which actions by the nurse will limit the risk of pulmonary aspiration of gastric contents? Select all that apply. A. Position the client in a side-lying position. B. Kink the end of the tube and pull the tube out steadily and smoothly. ​ C. Have the client blow their nose after removal. ​ D. Place a towel over the client's chest during the removal. ​ E. Have the client take a deep breath and hold it while removing the tube.​

B & E

The nurse is caring for several adolescents. Which statements are accurate about adolescent nutrition? Select all that apply. A. Growth rate slows so caloric needs decrease. B. Eating disorders often begin in adolescence. C. The desire for independence can lead to nutritional deficiencies. D. Adolescents are often concerned about body image, which may affect eating habits. E. Nutritional deficiencies are uncommon in adolescents.

B, C & D

Which are relevant when choosing equipment to insert a nasogastric tube for enteral feeding? Select all that apply. ​ A. Adults need a size 6 French tube that is 24 inches long.​ B. The flexibility of the tube may require a single-use stylet to insert.​ C. Small-bore feeding tubes are the most comfortable for adults.​ D. Fill a small cup with water and a straw. ​ E. Gather sterile disposable gloves for the procedure. ​

B, C & D

The nurse is caring for a client who is prescribed a full liquid diet. Which foods may be included on the lunch tray? Select all that apply. A. Scrambled eggs B. Custard C. Tomato soup D. Mashed potatoes E. Ice cream

B, C & E

A nurse is caring for several clients with alterations in bowel elimination. Which factors can influence bowel elimination? Select all that apply.​ A. Seasonal allergies B. Decreased peristalsis C. Diet preferences D. Physical activity E. Antibiotic therapy

B, C, D & E

The nurse is caring for a client who is undergoing radiation of the neck for esophageal cancer. Which nutritional issues should the nurse anticipate? Select all that apply. A. Severe constipation B. Anorexia C. Dysphagia D. Stomatitis E. Taste distortions

B, C, D & E

Which actions must occur before the removal of the tube? Select all that apply. ​ A. Position the client supine with a towel over the chest.​ B. Remove the securement device from the nose. ​ C. Perform hand hygiene and apply clean gloves. D. Verify the prescription from the healthcare provider for removal.​ E. Disconnect the tube from the enteral feeding administration set. ​

B, C, D & E

A nurse is providing education to a client who is prescribed enteral nutrition. Which statements made by the client indicate an understanding of the teaching?​ Select all that apply. A. "Enteral nutrition does not require a functioning gastrointestinal (GI) tract." B. "Enteral nutrition is often preferred over parenteral nutrition." C. "Enteral nutrition can be administered by a caregiver in the home."​ D. "Enteral nutrition must be administered via a nasogastric tube.​" E. "Enteral nutrition is administered continuously to critically ill clients.​" F. "Modular formula contains a single macronutrient." ​

B, C, E & F

A nurse is caring for a client who has just returned from the post-anesthesia care unit (PACU) after a surgical procedure. The client is arousable but very drowsy and slurs words when asking for water. Which action by the nurse is most appropriate? A. Offer the client small sips of water without a straw. B. Sit the client upright and provide water through a straw. C. Withhold all food and fluids until the client is awake and alert. D. Ask the client if they would like to eat a snack.

C

A nurse is caring for a client who needs a nasogastric tube inserted. Which assessment finding would prohibit insertion of the tube?​ A. Hypoactive bowel sounds​ B. Abdominal distention C. Basilar skull fracture​ D. Platelets 200,000 ​

C

The nurse is caring for a client who has a repaired fractured jaw and is prescribed a pureed diet. Which best describes a pureed diet? A. A diet in which all foods are modified in texture and require minimal chewing before swallowing. B. A diet consisting of any food and texture that the client desires. C. A diet in which all foods are pulverized in the blender. D. A diet in which all foods are liquid at room temperature and primarily consists of water and carbohydrates.

C

The nurse is caring for a client who has been on bedrest following a pulmonary blood clot and is taking opioid medications for pain. ​ Which bowel elimination alteration does the nurse anticipate?​ A. Diarrhea​ B. Nausea and vomiting​ C. Constipation D. Flatulence

C

The nurse is caring for a client with diverticulitis. Which type of diet does the nurse anticipate will be prescribed? A. Full liquid diet B. Pureed diet C. Low-fiber diet D. Mechanical soft diet

C

Which serum laboratory tests may indicate malnutrition? Select all that apply. A. White blood cell (WBC) count B. Thyroid-stimulating hormone (TSH) C. Prealbumin D. Albumin E. Blood urea nitrogen (BUN)

C & D

Which findings are used to describe bulimia nervosa? Select all that apply. A. It more commonly occurs during adulthood. B. It involves significant energy intake restriction relative to requirements. C. It involves episodes of binge eating. D. It is associated with a very low body weight. E. It is associated with self-induced vomiting or the use of laxatives or diuretics.

C & E

The nurse is caring for a client with Crohn's disease. Which prescribed therapeutic diets does the nurse anticipate? Select all that apply. A. Gluten-free diet B. Low-protein diet C. Low-fiber diet D. Low-fat diet E. Reduced-lactose diet

C, D & E

A nurse is caring for a client who is prescribed total parenteral nutrition. When the new bag of solution arrives from the pharmacy, it appears "cracked." Which action should the nurse take?​ A. Shake the bag of solution to mix components.​ B. Turn the bag upside down one time to agitate contents.​ C. Administer the bag of solution. ​ D. Return the bag to the pharmacy.​

D

A nurse is caring for an older adult client who is retired but very active in the community. The client exercises daily and enjoys cooking healthy meals with their partner. Is this client at risk for aspiration? A. Yes, because of the client's age. B. Yes, because of the client's active lifestyle. C. No, because the partner likely monitors the client while eating. D. No, because the client has no risk factors for aspiration.

D

A nurse is caring for an older adult client with muscular dystrophy in the emergency department (ED). The client's speech is abnormal, and lip and tongue movements appear delayed. The client has lost 7 pounds in the past 2 weeks. Secretions are thick, and the skin appears rough and dry. Which is the priority action taken by the nurse? A. The client is malnourished, so prepare to feed the client immediately. B. Document the findings as common symptoms of muscular dystrophy. C. Offer the client water to drink through a straw. D. Place the client on nothing by mouth (NPO) status and notify the healthcare provider.

D

At what temperature should the enteral nutrition (EN) formula be administered? A. Any temperature is acceptable B. At 32°F C. At least 120°F​ D. At room temperature​

D

While inserting a nasogastric tube, the client begins to cough and oxygen saturation decreases. Which action taken by the nurse is most appropriate? ​ A. Have the client relax and take sips of water.​ B. Ask the client to breathe slowly and continue the insertion. ​ C. Stop the insertion and request a chest x-ray.​ D. Stop the insertion and withdraw the tube into the posterior nasopharynx. ​

D

A nurse is planning care for a client with a decreased level of consciousness. Which should be included in the plan of care? Select all that apply. A. Problem analysis would be impaired swallowing related to impaired level of consciousness. B. Primary interventions should be aimed at feeding the client as soon as possible. C. Primary interventions should be aimed at improving the client's ability to swallow. D. Problem analysis would be risk for aspiration due to impaired level of consciousness. E. Primary interventions should be aimed at preventing aspiration.

D & E

A nurse is caring for a client who observes Muslim dietary practices. Which of the following dietary items may need to be avoided? Select all that apply. A. Dairy products B. Unleavened bread C. Tobacco D. Fish E. Alcohol F. Pork

E & F