NUTRITION

A nurse is preparing a client for placement of a catheter for TPN. Which of the following access sites should the nurse plan to prepare for catheter insertion? A. Left antecubital vein B. Right subclavian vein C. Right femoral artery D. Left arm radial artery

Right subclavian vein The right subclavian vein is the most common access site for total parenteral nutrition.

A nurse is instructing a group of adult clients about nutrition. The nurse should include which of the following as the recommended amount of vegetables servings per day? A. 1/2 cup B. 1 cup C. 2 cups D. 2 1/2 cups

2 1/2 cups Based on a typical 2000-calorie diet, the daily vegetable serving should be at least 2 ½ cups per day.

A nurse is assessing a client who is receiving bolus enteral feedings. Which of the following lab values indicates 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

BUN 28 mg/dL A BUN of 28 mg/dL is above the expected reference range indicating dehydration and requires a change in the formula to increase the intake of water. Without adequate fluid intake, the kidneys may not be able to excrete nitrogenous waste products adequately.

A nurse is caring for a client who is postop following an appendectomy. The surgeon initially prescribes a clear liquid diet. Which of the following items should the nurse offer the client? SATA A. Broth B. Grape juice C. Nonfat milk D. Custard E. Lemon gelatin

Broth Grape Juice Lemon Gelatin

A nurse is providing care for a client who is 2 days postop following abdominal surgery and is about to progress from a clear liquid diet to full liquids. Which of the following items should the nurse tell the client he may now request to have on his meal tray? A. Cranberry juice B. Flavored gelatin C. Skim milk D. Chicken broth

Skim milk Full liquids include milk and milk products, so the client may now ask for skim milk.

A nurse is caring for a client in a long-tem care facility who is receiving enteral feedings via an NG tube. Which of the following actions should the nurse take prior to administering the tube feeding? A. Warm the feeding solution to body temperature. B. Place the client in low Fowler's position. C. Discard any residual gastric contents. D. Test the pH of gastric aspirate.

Test the pH of gastric aspirate. Before administering enteral feedings, the nurse should verify the placement of the NG tube. The only reliable method is x-ray confirmation, which is impractical prior to every feeding. Testing the pH of gastric aspirate is an acceptable method between x-ray confirmations.

A nurse is establishing health promotion goals for a female client who smokes cigarettes, has hypertension, and has a BMI of 26. Which of the following goals should the nurse include? A. The client will list foods that are high in calcium, which should be avoided. B. The client will walk for 30 min 5 days a week. C. The client will increase calorie intake by 200 cal per day. D. The client will replace cigarettes with smokeless tobacco products.

The client will walk for 30 min 5 days a week. CDC recommendations include engaging in a moderate exercise, such as walking, for a total of 150 min each week.

An older adult client who lives alone tells a clinic nurse that he is unable to drive himself to the store and is afraid to cook on the stove. Which of the following community resources should the nurse recommend for this client? A. Hospice care B. Meals on Wheels C. A rehabilitation facility D. Temporary Assistance for Needy Families (TANF)

Meals on Wheels Meals on Wheels is a service that delivers meals daily to older adults who need them, either at senior centers or directly to their homes. It is appropriate for the nurse to recommend this service for this client.

A nurse is teaching a client's adult son about how to position the client when administering enteral feedings at home. Which of the following statements by the son indicates an understanding of the teaching? A. "I will allow him to be in the position where he is most comfortable during the feeding." B. "I will elevate the head of the bed 10 degrees during the feeding." C. "I will turn him on his left side during the feeding." D. "I will have him sit in his chair during the feeding."

"I will have him sit in his chair during the feeding." The client should be placed in a Fowler's position or in a sitting position in a chair, which is the normal position for eating. This is the position that will prevent aspiration of fluid into the lungs and promote a gravitational flow.

A nurse is providing teaching about the Mediterranean diet to a client newly who has a new diagnosis of hypertension. Which of the following statements by the client indicates a need for further teaching? A. "I will limit my intake of red meat to twice weekly." B. "I can have dairy in moderate portions daily." C. "I can have fish two times a week." D. "I can drink wine in moderation."

"I will limit my intake of red meat to twice weekly." This statement by the client indicates a need for further teaching. Following the Mediterranean diet, red meat should be limited to two times monthly.

A nurse is teaching the partner of a client who had a stroke about dysphagia. Which of the following statements by the client's partner should indicate the nurse that the teaching was effective? A. My partner should cough while swallowing food." B. "My partner should place their food on the weaker side of their mouth when eating." C. "My partner should tilt their head forward when swallowing." D. "My partner should sit at a 30° angle while eating their meals."

"My partner should tilt their head forward when swallowing." Tilting the head forward when swallowing decreases the risk for aspiration in a client who has dysphagia.

A nurse is caring for a client who is receiving TPN. The nurse notices that the solution bag is almost empty and there is not another bag of TPN to administer. Which of the following IV solutions should the nurse administer until the next bag of TPN solution is available? A. 10% dextrose in water (D10W) B. 0.45% sodium chloride (0.45% NaCl) C. Lactated Ringer's solution D. 5% dextrose in lactated Ringer's solution (D5LR)

10% dextrose in water (D10W) TPN solution has a high concentration of glucose and protein and is hyperosmotic; therefore, the nurse should administer D10W or 20% dextrose in water if there is not another bag of TPN solution available. This will ensure that the client receives the adequate amount of glucose and a solution with the appropriate osmolarity until another TPN solution is available.

A nurse is preparing to instill 840 mL of enteral nutrition via a client's gastrostomy tube over 24 hr using an infusion pump. The nurse should set the infusion pump to deliver how many mL/hr?

35

A nurse is caring for a client who is postop following an appendectomy and is prescribed D5 lactated Ringer's at 150mL/hr by continuous IV infusion for 12 hr. The drop factor of the manual IV tubing is 20gtt/mL. The nurse should set the manual IV infusion to deliver how many gtt/min?

50

A nurse is caring for a client who to receive liquid medications via gastrostomy tube. The client is prescribed phenytoin 250mg. The amount available is phenytoin oral solution 25mg/5mL. How many mL should the nurse administer per dose?

50

A nurse is preparing to administer a TPN 1800mL to infuse over 24 hr. The nurse should set the IV pump to deliver how many mL/hr?

75

A nurse is preparing to administer dextrose 5% in water 150mL IV to infuse over 3 hr. The drop factor of the manual IV tubing is 10gtt/mL. The nurse should set the manual IV infusion to deliver how many gtt/min?

8

A nurse is teaching a client about snacks that are appropriate on a low-fat, low-sodium, and low-colesterol diet. Which of the following choices by the client indicates the need for further teaching? A. slice of cheese B. A jam sandwich C. A cup of plain popcorn D. A small container of applesauce

A slice of cheese The client should limit the intake of cheese due to high levels of fat and sodium.

A nurse is caring for a client who is well-hydrated and who demonstrates no evidence of anemia. Which of the following lab values gives the nurse an assessment of the adequacy of the client's protein uptake and synthesis? A. Albumin B. Calcium C. Sodium D. Potassium

Albumin Albumin levels reflect the overall body protein status and is used to detect metabolic and liver dysfunction.

A nurse in an outpatient clinic is assessing a middle adult client as part of a routine physical examination. The client's BP is 142/88 mm Hg, his BMI is 31, and he is a current smoker. The nurse should identify that this client has multiple risk factors for which of the following disorders? A. Testicular cancer B. Cardiovascular disease C. Depression D. Thyroid disease

Cardiovascular disease Risk factors for cardiovascular disease include BP elevation, obesity, smoking, and a sedentary lifestyle.

A nurse is assessing a client who is receiving TPN therapy via an infusion pump. Which of the following actions should the nurse take? A. Obtain the client's blood glucose every 12 hr. B. Change the IV tubing every 24 hr. C. Change the IV site dressing every 4 days. D. Weigh the client every other day.

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

A nurse prepares to replace the nearly empty container of 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

Dextrose 10% in water 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 planning care for a client who has a 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 8 hr. D. Check residual volume every 4 to 6 hr.

Elevate the head of the client's bed 30° to 45°. 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 30o to 45o to promote gastric emptying and reduce the risk of aspiration.

A nurse is instructing a client's family members about feeding safety for a client who has dysphagia following a stroke. Which of the following instructions should the nurse include? A. Encourage brief exercise before meals to promote appetite. B. Place food in the affected side of the mouth. C. Encourage the client to take small bites. D. Place the client with the head reclined back to facilitate swallowing.

Encourage the client to take small bites. The family members should encourage the client to take small bites and chew food thoroughly in order to prevent choking.

A nurse is caring for a client who has a prescription for a clear liquid diet. Which of the following foods should the nurse allow the client to have? A. Grape juice B. Lemon sherbet C. Milkshake D. Vanilla ice cream

Grape juice A clear liquid diet includes foods that are fluids and clear at body and room temperatures. This includes apple and grape juices, broth, black coffee, and plain gelatin.

A nurse on the day shift is preparing to change a client's 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.

Hang dextrose 10% in water (D10W) until the TPN solution is delivered. 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 assessing a client who is receiving TPN. Which of the following findings should the nurse recognize as a complication of this therapy? A. Hyperglycemia B. Aspiration C. Diarrhea D. Stomatitis

Hyperglycemia 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 planning care for a client who has acute dysphagia. Which of the following nursing interventions should be included in the plan of care? A. Providing a straw for consumption of liquids B. Encouraging larger bites C. Placing the client in semi-Fowlers position during meals D. Instructing the client to tilt head forward when swallowing

Instructing the client to tilt head forward when swallowing The client should be instructed to tilt the head forward to facilitate swallowing.

A nurse is caring for a client who is receiving TPN via a peripherally inserted PICC. When assessing the client, the nurse notes swelling of the client'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. Remove the PICC line. D. Apply a cold pack to the client's upper arm.

Measure the circumference of both upper arms. 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 is planning care for four clients and is assigning tasks to a LPN and AP. Which of the following should the nurse assign to the LPN? A. Complete an admission assessment for a client who has COPD. B. Measure I&O for a client who has an indwelling urinary catheter. C. Reinforce teaching to a client to begin taking enoxaparin at home following a hip arthroplasty. D. Develop a plan of care for a client who has cholecystitis.

Reinforce teaching to a client to begin taking enoxaparin at home following a hip arthroplasty. Reinforcing teaching with a client is within the scope of practice of a LPN; therefore, the RN should delegate this task to the LPN.

A nurse is caring for a client following a CVA 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

Supplements via nasogastric tube Supplements via nasogastric tube provide enteral nutrition for clients who are at risk for aspiration caused by a diminished gag reflex or difficulty swallowing. This nutritional therapy will likely be prescribed.

A nurse is teaching a client about foods that are included on a clear liquid diet. Which of the following food choices made by the client indicates the need for further teaching? A. Yogurt B. Popsicle C. Gelatin D. Broth

Yogurt Yogurt is allowed on a full liquid diet, not a clear liquid diet.

A nurse is providing teaching to a client who is pregnant and is vegan. The nurse should instruct the client that which of the following foods is a reliable source of Vitamin B12? A. Tempeh B. Algae C. Sea vegetables D. Sunflower margarine

Sunflower margarine Sunflower margarine is fortified with vitamin B12 and is a reliable source of vitamin B12.

A nurse is teaching a client about preparing low-fat meals. The nurse should include the which of the following oils contains saturated fat? A. Corn B. Olive C. Canola D. Coconut

Coconut Coconut oil is semi-solid at room temperature and is considered a saturated fat.

A nurse is caring for a client who is postop following abdominal surgery. The surgeon initially prescribes a clear liquid diet. Which of the following items should the nurse include on the client's lunch tray? A. Lemon sherbet B. Plain yogurt C. Cranberry juice D. Carrot juice

Cranberry juice Cranberry juice is an acceptable component of a clear liquid diet, along with apple juice and grape juice

A nurse is caring for a client who requires TPN. Which of the following actions should the nurse take when finding that the TPN solution is infusing too rapidly? A. Turn the client on his left side. B. Sit the client upright. C. Prepare to add insulin to the TPN infusion. D. Stop the TPN infusion.

Sit the client upright. Fluid overload can cause dyspnea. The nurse should slow the infusion rate and sit the client upright to help prevent or treat dyspnea. The nurse should also administer oxygen if necessary.

A nurse is preparing to administer morphine sulfate 2 mg IV bolus. Available is morphine sulfate 10mg/mL. How many mL should the nurse administer per dose?

0.2

A nurse is planning care for a client who is to start receiving TPN. Which of the following interventions should the nurse include the plan of care? A. Use a 1.2 micron filter when infusing TPN with fat emulsions added. B. Allow 18 hr for the lipids to infuse when not mixed with the TPN solution. C. Change the TPN solution after 36 hr. D. Change the TPN tubing every 48 hr.

Use a 1.2 micron filter when infusing TPN with fat emulsions added. 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 providing discharge teaching to a client who will be receiving TPN at home. Which of the following instructions should the nurse include? SATA A. "Keep the TPN refrigerated when not in use." B. "Infuse 10 percent dextrose and water if the solution runs out." C. "Shake the TPN bag with fat emulsion if precipitate is present." D. "Stop using TPN once weight gain is achieved." E. "Maintain TPN infusion rate when behind schedule."

"Keep the TPN refrigerated when not in use." is correct. TPN should be stored in the refrigerator to maintain the integrity of the substances. These ingredients provide nutritional support and daily requirements to clients who cannot eat food by mouth or achieve nutrition from a diet for more than a week. TPN is required by clients who have pancreatitis, ulcerative colitis, Crohn's disease, burn injury, cancer, AIDS, and starvation. "Infuse 10 percent dextrose and water if the solution runs out." is correct. The nurse should infuse 10% dextrose and water at the same rate if the next TPN is not available to maintain blood glucose levels and prevent hypoglycemia. "Shake the TPN bag with fat emulsion if precipitate is present." is incorrect. If precipitate is present, such as white crystals, it should not be used and should be returned to the pharmacy. To preserve the integrity of the TPN contents, the client should be instructed to gently rock the TPN bag back and forth, up and down. This action gently blends the solution in the bag prior to administration. The force of shaking the bag would negatively impact the molecular structure of the various substances contained in the TPN bag. "Stop using TPN once weight gain is achieved." is incorrect. The rate of TPN infusion should not be changed without the guidance of the provider. A weight gain or loss should be reported to the client's provider to make the necessary adjustment in TPN infusion rate. Abrupt discontinuation can impact of the client's glucose level and cause hyperglycemia or hypoglycemia. "Maintain TPN infusion rate when behind schedule." is correct. 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 teaching a group of adults about nutrition. The nurse should include which of the following amounts as an appropriate daily intake of fiber for adult women? A. 5 to 10 g B. 10 to 15 g C. 20 to 35 g D. 40 to 50 g

20 to 35 g The Adequate Intake (AI) for total fiber for women is 20 g per day; therefore, 10 g would not be adequate.

A nurse is plannig care for a client who is receiving enteral feedings through an NG tube. Which of the following actions should the nurse plan to take first? A. Aspirate the client's stomach contents. B. Hang the feeding bag 30 cm (12 in) above the client. C. Label the feeding bag with the date and time of the start of the feeding. D. Warm the feeding to room temperature.

Aspirate the client's stomach contents. The first action the nurse should take using the nursing process is to assess the residual stomach contents. The nurse should measure the stomach contents to assess whether the feeding is being absorbed by the client. The nurse might delay the tube feeding for a high residual to reduce the risk of aspiration.

A nurse is caring for a client who is receiving TPN. The pharmacy is delayed in supplying the client's next container of TPN. Which of the following fluids should the nurse infuse until the next container arrives? A. Dextrose 5% in water B. 0.9% sodium chloride C. Dextrose 10% in water D. Lactated Ringer's solution

Dextrose 10% in water TPN contains high concentrations of dextrose and proteins. To avoid hypoglycemia, the nurse should infuse dextrose 10% or 20% in water until the next container of TPN solution arrives.

A nurse is preparing to administer three liquid medications to a client who has an NG feeding tube with continuous enteral feedings. Which of the following actions should the nurse take? A. Mix the three medications together prior to administering. B. Dilute each medication with 10 mL of tap water. C. Maintain the head of the bed in a flat position for 30 min following medication administration. D. Flush the NG feeding tube with 30 mL of water immediately following medication administration

Flush the NG feeding tube with 30 mL of water immediately following medication administration The nurse should flush the NG feeding tube with 15 to 60 mL of sterile water following medication administration to ensure the feeding tube is cleared of the medications.

A nurse is developing an education program for a community group about dietary intake of vitamins and minerals in the diet. The nurse should include which of the following foods as sources of vitamin C? SATA A. Green pepper B. Orange C. Cabbage D. Strawberries E. Milk

Green pepper is a correct response. Green peppers are a source of vitamin C and should be included as a source of vitamin C. Orange is a correct response. Oranges are a good source of vitamin C and should be included as a source of vitamin C. Cabbage is a correct response. Cabbage should be included as a source of vitamin C. Strawberries is a correct response. Strawberries should be included as a source of vitamin C. Milk is an incorrect response. Milk is a source of other vitamins including vitamin B12 and vitamin B6, but not a source of vitamin C.

A nurse is caring for a client who has a large lower-leg ulcer. Which of the following foods should the nurse suggest to the client to provide the most protein for wound healing? A. Kidney beans B. Grilled salmon C. Peanut butter D. Raw spinach

Grilled salmon Poultry, fish, eggs, and beef are complete proteins and are optimal sources of protein to support wound healing.

A nurse is reviewing incident reports submitted during the previous month. The nurse should identify which of the following as a problem that should be reported to the risk manager? A. Reports routinely include the client's hospital number. B. Reports routinely omit the names of witnesses to the occurrence. C. Reports routinely list the identification number of any equipment involved. D. Reports routinely are completed within 24 hr after the incident.

Reports routinely omit the names of witnesses to the occurrence. Nurses should record the names of all witnesses to the incident. Omitting the names of witnesses is a problem that should be reported and corrected.

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

Shakiness and diaphoresis 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 client who is experiencing dysphagia. The nurse should recommend a referral to which of the following members of the health care team? A. Speech therapist B. Social worker C. Respiratory therapist D. Occupational therapist

Speech therapist A speech therapist assesses and makes recommendations for clients experiencing speech, language, and swallowing difficulties.

A nurse is caring for a client who receives intermittent enteral feedings through an NG tube. Before administering a feeding, the nurse should measure the gastric residual for which of the following purposes? A. To confirm the placement of the NG tube B. To remove gastric acid that might cause dyspepsia C. To determine the client's electrolyte balance D. To identify delayed gastric emptying

To identify delayed gastric emptying The nurse should measure the amount of unabsorbed formula from the previous enteral feeding to identify delayed gastric emptying. If it is delayed, the nurse should avoid overfeeding the client and causing gastric distention.