Nutrition Exam 1 Practice Questions
Sequence the procedure for verifying feeding tube placement. A) Measure pH of aspirate. Compare the color of the strip with the color on the chart provided by the manufacturer. B) Discard used supplies, remove gloves and discard, and perform hand hygiene. C) Draw back on syringe and obtain 5 to 10 mL of gastric aspirate. Observe appearance of aspirate. D) Perform hand hygiene. Apply clean gloves. Draw up 30 mL of air into syringe, then attach to end of feeding tube. Flush tube with 30 mL of air.
1. D) Perform hand hygiene. Apply clean gloves. Draw up 30 mL of air into syringe, then attach to end of feeding tube. Flush tube with 30 mL of air. 2. C) Draw back on syringe and obtain 5 to 10 mL of gastric aspirate. Observe appearance of aspirate. 3. A) Measure pH of aspirate. Compare the color of the strip with the color on the chart provided by the manufacturer. 4. B) Discard used supplies, remove gloves and discard, and perform hand hygiene.
Match the following function with the hormone or Neurotransmitter. 1. Antidiuretic hormone (ADH) 2. Aldosterone 3. Catecholamines (epinephrine and norepinephrine) 4. Adrenocorticotropic hormone (ACTH) 5. Glycogen A. stimulate hepatic glycogenolysis, fat mobilization, gluconeogenesis B. causes release of cortisol to mobilize amino acids from skeletal muscles C. stored form of glucose found in the liver D. corticosteroid that causes renal sodium retention E. promotes conservation of water and salt to support circulating blood volume
1. E 2. D 3. A 4. B 5. c
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
1. c. Verify tube placement 2. a. Check the residual feeding contents 3. d. Administer the feeding 4. b. Evaluate tolerance of feeding
A 35 year old male patient has superficial partial-thickness burns to the anterior right arm, posterior left leg, and anterior head and neck. Using the Rule of Nines, calculate the total body surface area percentage that is burned?
18%
A 35 year old male patient has full thickness burns to the anterior and posterior head and neck, front of left leg, and perineum. Using the Rule of Nines, calculate the total body surface area percentage that is burned?*
19%
A nurse is caring for a client who weighs 80kg (176lb) and is 1.6 m (5ft 3 in) tall. Calculate the body mass index (BMI) and determine whether the client's BMI indicates a healthy weight, underweight, overweight, or obese.
31.2 obese
A 25 year old female patient has sustained burns to the back of the right arm, posterior trunk, front of the left leg, anterior head and neck, and perineum. Using the Rule of Nines, calculate the total body surface area percentage that is burned?
37%
A patient has finished a 16-oz container of orange juice. The intake and output sheet documents fluid in milliliters. Which of the following should the nurse document as intake?
480 mL 1 fluid oz= 30 mL 16 fluid oz= 480 mL
A 68 year old male patient has partial thickness burns to the front and back of the right and left leg, front of right arm, and anterior trunk. Using the Rule of Nines, calculate the total body surface area percentage that is burned?
58.5%
A 58 year old female patient has superficial partial-thickness burns to the anterior head and neck, front and back of the left arm, front of the right arm, posterior trunk, front and back of the right leg, and back of the left leg. Using the Rule of Nines, calculate the total body surface area percentage that is burned?
63%
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 66 year old female patient has deep partial-thickness burns to both of the legs on the back, front and back of the trunk, both arms on the front and back, and front and back of the head and neck. Using the Rule of Nines, calculate the total body surface area percentage that is burned?*
81%
A client who is recovering from a surgery has been ordered to be on a soft diet. The nurse would not offer which item to the client? A. Popsicle B. Bananas C. Yogurt D. Mashed potatoes
A
A group of nursing students are studying together. They are discussing the differences between parenteral and enteral nutrition. Which statement, if made by one of the students, indicates further instruction is needed? A) "Parenteral nutrition is the administration of nutrients directly into the GI tract by way of a feeding tube." B) "Enteral nutrition is preferred because it is less expensive than parenteral nutrition and maintains functioning of the gut." C) "An example of the parenteral route is subcutaneous or IM injections, or the IV route." D) "Gastric feedings may be given to patients with a low risk of aspiration. If there is a risk of aspiration, jejunal feeding is the preferred method. Parenteral nutrition is provided if the patient's GI tract is nonfunctional."
A
A group of nursing students are studying together. They are discussing the differences between parenteral and enteral nutrition. Which statement, if made by one of the students, indicates further instruction is needed? A) "Parenteral nutrition is the administration of nutrients directly into the GI tract by way of a feeding tube." B) "Enteral nutrition is preferred because it is less expensive than parenteral nutrition and maintains functioning of the gut." C) "An example of the parenteral route is subcutaneous or IM injections, or the IV route." D) "Gastric feedings may be given to patients with a low risk of aspiration. If there is a risk of aspiration, jejunal feeding is the preferred method. Parenteral nutrition is provided if the patient's GI tract is nonfunctional."
A
A nurse is administering a tube feeding for a patient who is post bowel surgery. When attempting to aspirate the contents, the nurse notes that the tube is clogged. What would be the nurse's next action following this assessment? a. Use warm water or air and gentle pressure to remove the clog. b. Use a stylet to unclog the tubes. c. Administer cola to remove the clog. d. Replace the tube with a new one.
A
A patient had an NG feeding tube inserted 1 week ago. You notice that the patient's nasal mucosa is inflamed, and the patient complains of pain at the site of insertion. The other naris appears patent with intact skin. What is the best action to take at this time? A) Call the physician; get an order to remove the feeding tube and insert a new feeding tube in the opposite naris. B) Remove the feeding tube and reinsert it in the opposite naris. C) Apply triple antibiotic ointment at the site of insertion and leave the tube in place. D) Medicate the patient for pain and stop using the feeding tube.
A
For intestinal placement of a feeding tube, in what position should the nurse place the patient while waiting for radiological confirmation of correct placement? A) On the patient's right side B) In a high-Fowler's position C) In a left lateral position D) Lying flat
A
The nurse suspects the patient's feeding tube has migrated. Which of the following would indicate the greatest risk related to tube migration? A) Dyspnea and decreased oxygen saturation B) Pain and gastric aspirate hemoccult positive C) Absence of bowel sounds D) Inability to flush the feeding tube
A
What is the most common carbohydrate used for TPN? A. Dextrose B. Fructose C. Invert sugar D. Lactose
A
Which of the following is an appropriate nursing action to prevent a complication of NG tube feedings? A) Keeping the head of the patient's bed elevated at least 30 degrees B) Leaving the feeding tube unclamped and unplugged between feedings C) Allowing the syringe to empty of feeding before adding more to the syringe D) Changing the feeding tube bag and tubing every 72 hours for a continuous feeding
A
You have just reported to the burn unit to start your shift. Four new patients have been admitted in the past 12 hours. Which patient is most likely to have life-threatening complications? A) A 4-year-old scald victim burned over 24% of the body B) A 27-year-old healthy male burned over 36% of his body in a car accident C) A 39-year-old female with myasthenia gravis burned over 18% of her body D) A 60-year-old male burned over 16% of his body in a brush fire
A
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' 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
To assess a stroke patient for complications secondary to inadequate swallowing, the nurse should do which of the following? A. Auscultate the patient's lungs B. Place the tip of a tongue depressor on the patient's posterior tongue C. With a penlight, inspect the patient's uvula and the soft palate D. Place fingers on the patient's throat tat he level of the larynx and ask him to swallow
A) Auscultate the patient's lungs "Silent" aspirations are a common complication of swallowing impairment
A client who is recovering from a surgery has been ordered a change from a full liquid diet to a clear liquid diet. The nurse would offer which item to the client? SELECT ALL THAT APPLY A. Popsicle B. Carbonated beverages C. Gelatin D. Pudding
A, B, C
Which of the following patients may benefit from enteral nutrition? (Select all that apply.) A) A patient who has a brain injury B) A patient with oral cancer C) A patient with paralytic ileus D) A patient with burns of the lower extremities
A, B, D
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 evaluating patients to determine their need for parenteral nutrition (PN). Which patients would be the best candidates for this type of nutritional support? Select all that apply. a. A patient with irritable bowel syndrome who has intractable diarrhea b. A patient with celiac disease not absorbing nutrients from the GI tract c. A patient who is underweight and needs short-term nutritional support d. A patient who is comatose and needs long-term nutritional support e. A patient who has anorexia and refuses to take foods via the oral route f. A patient with burns who has not been able to eat adequately for 5 days
A, B, F
A nurse is evaluating a patient following the administration of an enteral feeding. Which findings are normal and are criteria that indicate patient tolerance to the feeding? Select all that apply. a. Absence of nausea, vomiting b. Weight gain c. Bowel sounds within normal range d. Large amount of gastric residue e. Absence of diarrhea and constipation f. Slight abdominal pain and distention
A, C, E
The nurse is preparing information for a community seminar on the hazards of obesity. Which disorders should the nurse include as being complications of obesity? Select all that apply. A. cardiovascular diseases B. obstructive sleep apnea C. diabetes mellitus type 2 D. hypotension E. renal insufficiency
A,B,C Obesity leads to atherosclerosis, which increases vascular resistance, predisposing the patient to cardiovascular diseases. Respiratory airway collapse can occur during sleep in obese patients. Obesity increases the risk of developing diabetes mellitus type 2 in adults.
The nurse is planning care for a patient scheduled for bariatric surgery. Which interventions should the nurse include that support the diagnosis Imbalance Nutrition: More than body requirements? (Select all that apply) A. Establish realistic weight loss goals. B. Determine realistic activity objectives. C. Review behavior modification strategies. D. Determine strategies to prevent stress eating. E. Set small goals and offer positive encouragement.
A,B,C The intervention appropriate for the diagnosis of Imbalanced Nutrition: More than body requirements include establish realistic weight loss goals. determine realistic activity objectives, and review behavior modification strategies.
The nurse is planning care for a patient with anorexia nervosa. Which problem should the nurse identify as a priority for this patient? A. inadequate oral intake B. feelings of adequacy C. loss of control D. skewed opinion of appearance
A. An inadequate oral intake negatively impacts all physiological processes. This is the priority for the patient at this time.
The mother of a teen is concerned that her daughter's nutritional status is compromised since the daughter has an increased interest in losing weight, weighs herself several times each day, and at times ingests large amounts of food. The daughter has not lost or gained much weight, but the mother wonders if her daughter has anorexia nervosa. How should the nurse respond to this mother? A. These are behaviors consistent with bulimia nervosa. B. These are behaviors consistent with early-onset anorexia nervosa. C. These are behaviors consistent with binge-eating disorder. D. These are behaviors consistent with a metabolic disorder.
A. Bulimia nervosa is a disorder in which patients eat large quantities of foods and then purge themselves by means of vomiting. Laxatives also may be employed.
The nurse is caring for an adolescent with anorexia nervosa. What should the nurse include in this patient's plan of care? A. Provide a variety of cold or room temperature foods B. Serve the patient three balanced meals per day. C. Discuss weight-gain needs with the patient. D. Observe the patient's activities for 15 minutes after eating.
A. Cold or room temperature foods are often more appealing to patients with anorexia nervosa.
The nurse is reviewing the lipid panel of a patient with a body mass index (BMI) of 31. What should the nurse expect this patient's values to be? A. low high-density lipoprotein (HDL) B. elevated HDL C. normal thyroid hormone (TH) level D. low-density lipoprotein (LDL)
A. LDL levels are elevated in obese patients.
The client who is morbidly obese has undergone gastric bypass surgery. Which immediate postoperative intervention has the greatest priority? A. Monitor respiratory status. B. Weigh the client daily C. Teach a healthy diet. D. Assist in behavior modification.
A. The morbidly obese client will have a large abdomen, preventing the lungs from expanding, which predispose the client to respiratory complication.
Three days after gastric bypass surgery, a patient complain of increasing abdominal pain. Bowel sounds are absent and the abdomen is firm and very tender. What should the nurse do first? A. Report findings to the surgeon. B. Evaluate the effectiveness of analgesia. C. Ambulate the patient to promote peristalsis. D. Chart assessment data and continue to monitor.
A. The risk for postoperative complications after bariatric surgery is high. One of the postoperative complications with gastric bypass surgery is an anastomotic leak causing peritonitis.
The nurse is preparing to administer total parenteral nutrition intravenously to a patient with malnutrition. What fat soluble vitamin should the nurse note is absent from the nutritional mixture? A. vitamin K B. vitamin A C. vitamin D D. vitamin E
A. Vitamin K is the only fat soluble vitamin that cannot be administered intravenously.
The nurse teaches a patient about the medication orlistat (Xenical). Which patient statement indicates the need for additional teaching? A. "I should take this medication 30 minutes before eating." B. "This medication will reduce the amount of fat my body absorbs." C. "I will need to take supplements of vitamins A, D, E, and K daily." D. "A low-calorie diet will need to be followed."
A. When dieting, a small nonfood reward can serve as an incentive for working toward a goal.
A patient diagnosed with obesity asks about the appetite suppressant phentermine to assist with a weight loss program. Which information in the patient's health history might restrict the patient's ability to take this medication? A. Frequent use of alcohol B. History of narcolepsy C. A family history of thrombophlebitis D. A body mass index of 31kg/m2
A. Alcohol use or abuse can be contraindication for this medication.
A nurse is caring for a client who is receiving total parenteral nutrition. The nurse should monitor the client for which of the following conditions as a complication of TPN? A. Polyuria B. Aspiration C. Abdominal distension D. Stomatitis
A. Polyuria
The nurse is caring for a patient experiencing dysphagia. Which interventions help decrease the risk of aspiration during feeding? (Select all that apply.) A. Sit the patient upright in a chair. B. Give liquids at the end of the meal. C. Place food on the strong side of the mouth. D. Provide thin foods to make it easier to swallow. E. Feed the patient slowly, allowing time to chew and swallow. F. Encourage the patient to lie down to rest for 30 minutes after eating.
A. Sit the patient upright in a chair. C. Place food on the strong side of the mouth. E. Feed the patient slowly, allowing time to chew and swallow.
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. protein
A nurse is reviewing a client's lab results. Which of the following labs should the nurse report to the provider? A. Sodium 126 mEq/L B. Potassium 3.6 mEq/L C. Magnesium 1.9 mEq/L D. Chloride 99 mEq/L
A. sodium 126 mEq/L
A client receiving total parenteral nutrition (TPN) exhibits symptoms of congestive heart failure (CHF) and pulmonary edema. Which complication of TPN is the client most likely experiencing? A. Calcium imbalance B. Fluid volume deficit C. Fluid volume overload D. Potassium imbalance
ANS: C Congestive heart failure and pulmonary edema are symptoms of fluid overload
To evaluate an obese patient for adverse effects of lorcaserin (Belviq), which action will the nurse take? a. Take the apical pulse rate. b. Check sclera for jaundice. c. Ask about bowel movements. d. Assess for agitation or restlessness.
ANS: C Constipation is a common side effect of lorcaserin
The nurse is preparing to administer medication using a client's nasogastric tube. Which actions should the nurse take before administering the medication? Select all that apply. 1. Check the residual volume. 2. Aspirate the stomach contents. 3. Turn off the suction to the nasogastric tube. 4. Remove the tube and place it in the other nostril. 5. Test the stomach contents for a pH indicating acidity.
ANSWER: 1, 2, 3, 5 Rationale: By aspirating stomach contents, the residual volume can be determined and the pH checked. A pH less than 3.5 verifies gastric placement. The suction should be turned off before the tubing is disconnected to check for residual volume; in addition, suction should remain off for 30 to 60 minutes following medication administration to allow for medication absorption. There is no need to remove the tube and place it in the other nostril in order to administer a feeding; in fact, this is an invasive procedure and is unnecessary.
An RN who usually works on the pediatric unit is floated to the GI medical-surgical unit. Which client is appropriate for the charge nurse to assign to the float nurse? A. 20-year-old with anorexia nervosa receiving total parenteral nutrition (TPN) through a central venous line B. 35-year-old who had a laparoscopic gastroplasty yesterday and is now taking sips of clear liquids C. 60-year-old with gastric cancer receiving elemental feedings through a jejunostomy tube D. 65-year-old with morbid obesity who requires a preoperative bariatric surgery assessment
Answer A. A pediatric nurse would be familiar with the pathophysiology and collaborative treatment of the client with anorexia nervosa.
Which client on a medical-surgical unit does the charge nurse assign to the LPN/LVN? A. 28-year-old with morbid obesity who had bariatric surgery today B. 30-year-old recently admitted with severe diarrhea and Clostridium difficile infection C. 36-year-old whose family needs instruction about how to use a gastric feeding tube D. 39-year-old with a jejunal feeding tube who needs elemental feedings administered
Answer D Correct: LPN/LVN education includes administration of tube feedings and associated client care and monitoring.
A client is discharged home with an enteral feeding tube. What does the home health nurse do to determine the patency of the client's enteral tube? A. Arranges for the client to have an x-ray performed periodically B. Auscultates the client's abdomen for bowel sounds before each feeding C. Instills air into the tube to check for placement and patency before each feeding D. Tests aspirated tube contents for pH level before each feeding Correct
Answer D. This is considered to be the most accurate method for confirming enteral tube placement.
A nurse is calculating the body mass index (BMI) of a 35-year-old male patient who is extremely obese. The patient's height is 5′6″ and his current weight is 325 lb. What would the nurse document as his BMI? a. 50.5 b. 52.4 c. 54.5 d. 55.2
B
Erin has just been diagnosed with a peptic ulcer and has been bleeding internally for months. As a result, she now has an iron deficiency. What type of malnutrition is she suffering from? A. Primary malnutrition B. Secondary malnutrition C. Malabsorption malnutrition D. Overt malnutrition
B
If the nurse suspects the NG feeding tube has migrated, the nurse should: A) Instill 10 mL of water into the feeding tube, reinsert the stylet, and reposition the tube. B) Stop any enteral feedings and obtain an order for a chest x-ray to determine placement. C) Irrigate the tube with tap water. D) Reposition the patient from side to side
B
The patient begins to cough and choke as the nurse is inserting the NG tube. What is the best action for the nurse to take at this time? A) Pull the feeding tube out and start over in the opposite naris. B) Pull the tube back and attempt to reinsert. C) Instruct the patient to take small sips of water and swallow. D) Auscultate over the carina.
B
Which of the following is NOT an appropriate technique for administering enteral formulas? A) Continuous feeding pump B) Through a large vein C) Intermittent gravity drip D) Large-bore syringe (bolus)
B
Protein requirements daily for someone under moderate stress would be: A. 1.5 to 2.0 g/kg body weight B. 1.0 to 1.5 g/kg body weight C. 0.2 to 0.4 g/kg body weight D. 0.8 g/kg body weight
B A. NO - Severe Stress C. No D. NO - Normal stress
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 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 assessing a client and discovers the infusion pump 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 caring for a patient who has sustained a head injury and whose level of consciousness fluctuates. The provider prescribes a full liquid diet progressing to a pureed diet as tolerated. Before initiating feedings, it is essential that this patient undergo which of the following? A) CXR B) Swallowing Examination C) Nasogastric tube Insertion D) Olfactory nerve evaluation
B) Swallowing Examination Patients at high risk for aspiration include those with a decreased level of consciousness. This patient has some periods of decreases alertness, thus a swallowing examination is essential to determine his ability to ingest food safely by mouth.
When the body is under stress, which of the following occur? SELECT ALL THAT APPLY A. Blood sugar decreases B. Heart Rate increases C. Blood Pressure increases D. Respiratory rate increases E. Pupils constrict
B, C
The physician just left the patient's room after explaining the options of NG or NI feeding tube placement. A student asks a nurse about the differences between nasogastric and nasointestinal feedings. Which of the following are accurate statements made by the nurse? (Select all that apply.) A) Insertion of an NG tube requires clean gloves, whereas insertion of an NI tube requires sterile gloves. B) It would be unexpected for there to be more than 10 mL of gastric aspirate obtained from an NI tube or more than 200 mL from an NG tube. C) The advantage to an NI tube is that there is less risk for aspiration. D) NI tubes are used for patients with nasal problems such as nosebleeds or deviated septums. NG tubes are used for patients without nasal problems. E) Both NG and NI tubes are usually used for less than 30 days.
B, C, E
The client who is morbidly obese presents to the clinic before beginning a weight loss program. Which interventions should the nurse teach? (Select all that apply) A. Walk for 30 minutes three times a day. B. Determine situations that initiate eating behavior. C. Weigh at the same time every day. D. Limit sodium in the diet. E. Refer to a weight support group.
B,E The client should be aware of situations triggering the consumption of food when the client is not hungry, such as anger, boredom, and stress. Food-seeking behaviors are not associated only with hunger in the client who is obese. Weight loss support groups such as Weight Watchers or Take Off Pounds Sensibly are helpful to keep the client participating in a weight loss program.
A patient has a body mass index (BMI) of 27. How should the nurse explain this finding to the patient? A. normal weight B. overweight C. obese D. metabolic syndrome
B. A body mass index of 25-25.9 is considered overweight.
While reviewing the medical history, the nurse determines a patient is at risk for obesity. Which is the greatest risk factor for the development of obesity? A. Was adopted at two months of age. B. Does not engage in regular activity. C. Is allergic to chocolate and strawberries. D. Usual diet includes fat-food lunches twice a week.
B. Environmental influences and heredity contribute to the development of obesity. However, physical inactivity is the most important factor contributing to obesity.
The 22 year old female who is obese is discussing weight loss programs with the nurse. Which information should the nurse teach? A. Jog for two to three hours every day. B. Lifestyle behaviors must be modified. C. Eat one large meal every day in the evening. D. Eating 1,000 calories a day and don't take vitamins.
B. If lifestyle behaviors such as patterns of eating and daily exercise are not modified, the client who loses weight will regain the weight and usually more.
The nurse teaches a patient who has had surgery to increase which nutrient to help with tissue repair? A. Fat B. Protein C. Vitamin D. Carbohydrate
B. Protein
A patient hospitalized with chronic heart failure eats only about 50% of each meal and reports "feeling too tired to eat." Which action should the nurse take FIRST? A. Teach the patient about the importance of good nutrition B. Serve multiple small feedings of high-calorie, high-protein foods C. Consult with the health care provider about parenteral nutrition (PN) D. Obtain an order for enteral feedings of liquid nutritional supplements.
B. Serve multiple small feedings of high-calorie, high-protein foods
A nurse at a health fair is assessing the weight status of four clients. Which of the following clients are classified as overweight? A. A female client who has a body mass index of 24 B. a male client who has a body mass index of 29 C. a female client who has a waist circumference of 101.6 cm (40in) D. a male client who has a waist circumference of 96.52 cm (38in)
B. a male client who has a body mass index of 29
A nurse is caring for a client following a SVA and observes the client experiencing severe dysphagia. The nurse notifies the provider. Which of the following nutritional therapies will likely be prescribed? A. NPO until dysphagia subsides B. supplements via nasogastric tube C. initiation of total parenteral nutrition D. soft residue diet
B. supplements via nasogastric tube
Which of the following are common indicators for TPN therapy? A. Coma, citrate toxicity, and bowel surgery B. Renal failure, prolonged ileus, and gastrocutaneous fistulas C. Hepatic failure, hypermetabolic states, and malabsorption of enteral therapy D. Filtration, multiple trauma, and conditions requiring bowel rest
C
Why is it important to have the tube feeding at room temperature? A) It is unnecessary to keep the tube feeding cold because it will be hanging at room temperature anyway. B) It aids the speed of digestion. C) Cold formula can cause gastric cramping. D) Cold formula may lower the patient's body temperature.
C
You are to irrigate the patient's established feeding tube with 30 mL of tap water before instilling the tube feeding. Upon attempting to do so, you find that you are unable to instill the fluid. What should your next action be? A) Notify the physician. B) Irrigate the tubing with soda, such as Coca-Cola. C) Reposition the patient. D) Use a smaller-sized syringe with the plunger to push the fluid through the feeding tube.
C
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 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 caring for a patient who has impaired swallowing due to a cerebrovascular accident. Which of the following interventions should the nurse use to assist the patient with feeding? A) Provide the patient with a straw B) Offer the patient thin fluids C) Elevate the head of the bed 45 to 90 degrees D) Place food in the weaker side of the mouth
C) Elevate the head of the bed 45 to 90 degrees The patients head should be sufficiently elevated to prevent aspiration.
A nurse is performing a nutritional assessment. When obtaining and interpreting anthropometric values, the nurse should recognize which of the following? A) Isolated measurements of height and weight are of greater significance than changes over time B) A weight increase of 4lbs in a patient with renal failure indicates retention of 1000mL of fluid C) the patient should be weighed on the same scale at the same time each day D) the ratio of height to wrist circumference is the most accurate way to identify obesity
C) the patient should be weighed on the same scale at the same time each day Weighing a patient on the same scale at the same time of day provides the most consistent data for gauging trends in the patients weight, as shifts in fluid intake and output can alter weight significantly. The patient should also be weighed with he same amount of clothing and/or linen each time.
A nurse is collecting data from a client who is receiving intermittent enteral feedings. Which of the following laboratory values should the nurse identify as an indication that the client needs a change in the formula? A. Hematocrit 42% B. Urine specific gravity 1.022 C. BUN 28 mg/dL D. Sodium 142 mEq/L
C. BUN 28 mg/dL
A nurse is preparing to administer a bolus enteral feeding to a client who has a gastrostomy tube. Which of the following actions should the nurse take first? A. Measure stomach contents B. Flush the tube with water C. Elevate the head of the bed D. Return gastric content into the gastrostomy tube
C. Elevate the head of the bed
Which statement made by an adult patient demonstrates an understanding of healthy nutrition teaching? A. I need to stop eating red meat .B. I will increase the servings of fruit juice to four a day. C. I will make sure that I eat a balanced diet and exercise regularly. D. I will not eat so many dark green vegetables and eat more yellow vegetables.
C. I will make sure that I eat a balanced diet and exercise regularly.
Which of the following statements is false? A. A patient with a bowel obstruction would not be a good candidate for enteral nutrition B. Lactose malabsorption and celiac disease are food intolerances C. It is okay to mix medication with tube feeding formula D. Dietary Guidelines recommend 60-90 mins of moderate-to-vigorous-intensity activity on most days of the week to prevent weight gain.
C. It is okay to mix medication with tube feeding formula Do not mix them!! instead, mix meds with water or use the liquid form
Which of the following strategies for enhancing the intake of healthful foods is appropriate for an adolescent? A. Encouraging the adolescent to consume snack foods from the grains food group. B. Permitting the adolescent to skip breakfast to appetite at later meals C. Making healthful food choices more convenient and available for the adolescent D. Allowing the adolescent complete autonomy in making food choices
C. Making healthful food choices more convenient and available for the adolescent
A nurse is planning care for a patient who is chronically malnourished. Which action is appropriate for the nurse to delegate to unlicensed assistive personnel (UAP)? A. Assist the patient to choose high-nutrition items from the menu B. Monitor the patient for skin breakdown over the bony prominence C. Offer the patient the prescribed nutritional supplement between meals. D. Assess the patient's strength while ambulating the patient in the room.
C. Offer the patient the prescribed nutritional supplement between meals.
A nurse is inserting an NG tube. Identify the sequence the nurse should follow. A. Lubricate the tube B. Measure tube for placement C. Place client in high-Fowler's position D. Advance tube downward and backward E. Insert tube along the base of nares F. Check position of the tube and secure
C. Place client in high-Fowler's position B. Measure tube for placement A. Lubricate the tube E. Insert tube along the base of nares D. Advance tube downward and backward F. Check position of the tube and secure
A client who is recovering from a surgery has been ordered a change from a clear liquid diet to a full liquid diet. The nurse would offer which full liquid item to the client? A. Popsicle B. Carbonated beverages C. Gelatin D. Pudding
D
The nurse is going to administer a bolus enteral tube feeding of 240 mL. The nurse has obtained a pH of 4 and 50 mL of gastric aspirate. Based on these findings, what action should the nurse take? A) Stop the feeding and recheck the residual in one hour. B) Reposition the feeding tube under fluoroscopy. C) Discard the aspirate and continue with the bolus feeding as prescribed. D) Return the aspirate to the patient's stomach and administer the feeding.
D
What is the difference between a PEG tube and a gastrostomy tube? A) A PEG tube is inserted into the jejunum; a gastrostomy tube is located in the stomach. B) A PEG tube exits from the right upper quadrant and a gastrostomy tube exits from the upper left quadrant. C) A PEG tube is inserted through the abdominal wall and a gastrostomy tube is inserted through the nose. D) A PEG tube is inserted by using endoscopic visualization of the stomach and is held in place by its design; a gastrostomy tube is inserted surgically and is held in place by sutures.
D
Which of the following accurately describes the greatest risk related to having a feeding tube? A) Electrolyte imbalance B) Fluid volume overload C) Infection D) Aspiration
D
A patient arrives in the emergency department after being burned in a house fire. The patient's burns cover the face and the left forearm. What percentage of burn does the patient have? A) 10% B) 25% C) 9% D) 18%
D The face is 9%, and the forearm is 9% for a total of 18% in this patient.
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. Refeeding syndrome causes chronic whole body depletion of phosphorus. Also, the insulin surge causes a greatly increased uptake and use of phosphate in the cells
The nurse is identifying a diagnosis appropriate for a patient with obesity. Which diagnosis is the priority for a patient with a BMI of 30.4kg/m2 and a waist-to-hip ratio of 1.1? A. Ineffective Coping B. Deficient Knowledge: Diet C. Health-Seeking Behaviors: Weight Loss D. Risk for impaired Tissue perfusion: Cardiac
D. A BMI greater than 25 and central obesity as indicated by a waist-hip ratio of 1 or greater tend to have more intraabdominal fat and higher levels of circulating free fatty acids.
The 36 year old female client diagnosed with anorexia nervosa tells the nurse "I am so fat. I won't be able to eat today" Which response by the nurse is most appropriate? A. "Can you tell me why you think you are fat?" B. "You are skinny. many women wish they had you problem." C. "If you don't eat we will have to restrain you and feed you." D. "Not eating might cause physical problems."
D. It is a factual statement to the client about the possible results if the client about the possible results if the client refuses nourishment.
The nurse is providing discharge instructions to a patient recovering from bariatric surgery. Which patient statement indicates diet teaching has been effective? A. "I should drink fluids with meal to aid with digestion." B. "I should drink caffeinated carbonated liquids to aid with weight loss." C. "I can eat anything that I want because weight loss will occur regardless of food intake." D. "I should eat four to six small meals each day that are low fat, high in complex carbohydrates, and high in proteins."
D. Patients recovering from bariatric surgery should be instructed to avoid foods high in simple carbohydrates since this could precipitate dumping syndrome. Meals should by small and liquids and solids should not be taken together.
A patient on a reduced-calorie diet asks the nurse what she can do to lose weight faster, because most weeks she loses no more than 0.5lb. "At this rate, it will take me years to get to my goal!" What should the nurse respond to this patient? A. "Let's reevaluate your long-term goal. Perhaps it was set too low for you." B. "You sound frustrated. Would you like to take some time off from your diet and exercise plan?" C. "Perhaps we should look into a diet supplement since you are unable to stick with your prescribed diet plan" D. "A pound of body fat equals 3500 calories. Let's reevaluate your diet and exercise plan for calorie intake and expenditure."
D. The nurse should assist the patient to create attainable goals that incorporate achievement of improved health outcomes.
A 60-yr-old man who is hospitalized with an abdominal wound infection has been eating very little and states, "Nothing on the menu sounds good." Which action by the nurse will be MOST effective in improving the patient's oral intake? A. Order 6 small meals daily B. Make a referral to the dietitian C. Teach the patient about high-calorie foods. D. Ask family members to bring favorite foods.
D. Ask family members to bring favorite foods.
A charge nurse observes a nurse administer intermittent tube feedings via an NG tube to a client. Which of the following actions should prompt the charge nurse to intervene? A. The nurse initiates the feeding after aspirating 50 mL of gastric residual B. The nurse irrigates the NG tube with tap water after feeding C. The nurse administers the feeding through a syringe barrel by gravity D. The nurse allows the client to rest in a supine position during feeding
D. The nurse allows the client to rest in a supine position during feeding
A 19-yr-old woman admitted with anorexia nervosa is 5ft, 6in (163cm) tall and weighs 88lb (41kg). Laboratory test reveal hypokalemia and iron-deficiency anemia. Which patient problem has the highest priority? A. difficulty coping B. Disturbed body image C. Impaired nutritional status D. risk for electrolyte imbalance
D. risk for electrolyte imbalance
A nurse is caring for a client who is experiencing dysphagia. The nurse should recommend a referral to which of the following members of the healthcare team? a. occupational therapist b. social worker c. speech therapist d. respiratory therapist
c. speech therapist
A nurse is planning care for a client who has acute dysphagia. Which of the following nursing interventions should be included in the plan of care? a. Placing the client in semi-fowlers position during meals b. Providing a straw for consumption of liquids c. Encourage larger bites d. Instructing the client to tilt head forward when swallowing
d. Instructing the client to tilt head forward when swallowing