CH 39 EAQ Management of Nutritional Problems

A nurse is assessing the nutritional needs of a very active 50-year-old male patient. The patient's weight is 82 kg, and his height is 178 cm. What are the total daily calorie needs of the patient? Record the answer using a whole number and no punctuation.

ANS: 2911 calories The Mifflin-St. Jeor Equation is used for determination of total daily calorie needs. The energy expenditure is calculated and then multiplied by the appropriate activity factor. The formula for men is: Energy expenditure = 5 + 10(wt in kg) + 6.25(ht in cm) - 5(age) × activity factor. The activity factor for a very active man is 1725. The total daily calorie need of the patient is 2911. Energy expenditure = 5 + 10(82) + 6.25(178) - 5(50) × 1.725 = 2911.

The registered nurse observes another health care provider caring for a patient with multiple intravenous lines and a continuous enteral feeding in place. The nurse should intervene immediately when the care provider performs what action? a. Uses an IV pump to deliver the enteral feeding b. Teaches the visitors to notify the nurse if the enteral feeding line becomes disconnected c. Checks the patient's vital signs after making a connection d. During shift handoff, traces all tubes

ANS: A An enteral feeding misconnection is an inadvertent connection between an enteral feeding system and a non-enteral system such as an IV line, a peritoneal dialysis catheter, or a tracheostomy trach cuff. With an enteral feeding misconnection, nutritional formula intended for the GI tract is given IV or into the respiratory tract. Severe patient injury and death can result. The nurse should not use an IV pump or IV tubing to deliver an enteral feeding. The nurse should teach the visitors to notify the nurse if the enteral feeding line becomes disconnected. The nurse should check the patient's vital signs after making a connection. During shift handoff, the nurse should recheck connections and traces all tubes.

The nurse inserts a nasogastric tube. What method should be used to confirm that the tube is correctly placed in the patient's gastrointestinal tract? a. X-ray b. Endoscopy c. Capnography d. Bronchoscopy

ANS: A An x-ray confirmation helps determine whether a blindly placed nasogastric or orogastric tube is properly positioned in the gastrointestinal tract. An endoscopy is used to insert a gastrostomy tube. A capnography is used to detect an inadvertent entry of a tube into the trachea during insertion. A bronchoscopy helps diagnose the cause of pneumonic infiltrates.

A nurse inserts an orogastric tube in a patient for administration of enteral feeding. Which nursing action is a priority immediately after inserting the tube? a. Checking the tube position b. Placing the patient in upright position c. Checking the residual volume d. Elevating the head of bed

ANS: A Following the placement of a tube, it is important to determine its position. Placing the patient in a semi-Fowler's position is important to prevent aspiration but is not a priority intervention immediately after tube insertion. Checking the residual volume is important to determine whether the patient is tolerating the feedings. However, it is not a priority. Elevating the head of the bed prevents aspiration but is not a priority.

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

ANS: A Intravenous fat emulsions are not recommended for patients suffering from fever, hyperlipidemia, clotting problems, and respiratory disease; the nurse should discontinue IVFE to prevent complications. Slowing the rate of an emulsion administration will put the patient's safety at risk. The nurse cannot change the route of administration without consulting the patient's primary health care provider. Documenting the findings and continuing the infusion will put the patient's safety at risk.

The nurse is reviewing diagnostic study results for a patient with suspected malnutrition. When compared to other lab studies, which diagnostic test is considered to be the best indicator of current nutritional status? a. Prealbumin b. Transferrin c. Serum albumin d. Hemoglobin and hematocrit

ANS: A Prealbumin, a protein synthesized by the liver, has a half-life of 2 days. When compared to albumin, it is a better indicator of recent or current nutritional status. Serum transferrin level is another indicator of protein status. Transferrin, a protein synthesized by the liver and used to transport iron, decreases when protein is deficient. Serum albumin has a half-life of approximately 20 to 22 days. In the absence of marked fluid loss, such as from hemorrhage or burns, the serum albumin value lags behind actual protein changes by more than 2 weeks. Therefore, albumin is not a good indicator of acute changes in nutritional status. Hemoglobin and hematocrit are not the best indicators of current nutritional status.

The nurse is caring for a patient who is receiving enteral feedings of reconstituted formula. After completing the feeding, there is 50 mL of formula still in the bottle. The next feeding is due in five hours. What action should the nurse take? a. Discard the formula b. Refrigerate the formula c. Keep the formula in the room for the next use d. Give the formula to another patient

ANS: A The formula should be discarded because it may become contaminated. Used formula should not be refrigerated for further use. It should not be used for the next feeding because the next feeding is 5 hours later. Reconstituted formula should be discarded after 4 hours. It should not be used for other patients because it may not meet their nutritional demands.

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

ANS: B C D The ideal body mass index of an adult is between 18.5 kg/m 2 to 24.9 kg/m 2. A patient with body mass index below 18.5 kg/m 2 is considered to be underweight. Patients with body mass index below the adequate level need to be supplemented with a high-protein diet that includes eggs, nuts, and legumes. Salads and skim milk contain low levels of saturated fats and limited nutrients.

The health care team creates a collaborative plan of care for patients with nasogastric (NG) and gastric tubes and enteral feedings. What is a primary role of the registered nurse (RN)? a. To insert the nasogastric tube for an unstable patient b. To provide oral care to the patient c. To position the patient who is receiving enteral feeding with the head of bed elevated d. To weigh the patient who is receiving enteral feeding

ANS: A The registered nurse inserts nasogastric tubes for an unstable patient. The licensed practical nurse/licensed vocational nurse (LPN/LVN) inserts NG tubes for stable patients. Providing oral care to the patient, positioning the patient, and weighing the patient are the roles of unlicensed assistive personnel (UAP). Insertion and management of nasogastric and gastric tubes for enteral feeding may be subject to the policy and protocols of a health care facility. Many organizations establish that only an RN may insert a nasogastric tube. Additionally, most facilities have disposable collection devices for gastric tubes and prohibit emptying and reusing containers, instead requiring disposal of the waste and the vessel in appropriate biohazard receptacles.

A patient with an orofacial fracture receives enteral nutrition through a nasogastric (NG) tube. The nurse flushes the tube after medication administration to prevent what complication? a. Tube clogging b. Tube dislodgement c. Irritation of the lining of the stomach d. Administration of less than the prescribed amount of medication

ANS: A When a nasogastric tube is not flushed before and after a medication administration, tube clogging can result. Tube dislodgement occurs when a patient who has a nasogastric tube vomits or coughs. The lining of the stomach will not be affected by the small amount of flush that is used. The full amount of medication should be given through the tube prior to the flush.

A patient is scheduled for abdominal surgery for diagnostic exploration of unexplained abdominal pain. The nurse should instruct the patient to follow which type of diet during the weeks prior to the surgery? a. High-protein diet b. Low-calorie diet c. More fats in diet d. High-sodium diet

ANS: A Wound healing requires increased protein synthesis. For a patient undergoing major surgery, several weeks of increased protein and calorie intake are needed preoperatively to promote healing postoperatively. More fats or a high-sodium diet may lead to an increase in blood pressure and should be avoided.

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

ANS: A B The patient receiving feeding through an orogastric tube is at risk of skin irritation and dislodgment of the tube. Skin irritation occurs because the digestive juice irritates the skin. If the skin is irritated, other types of drain or tube pouches are used. The tubes can become dislodged by vomiting or coughing and can also become knotted or kinked. Fluid retention and electrolyte imbalances are symptoms of refeeding syndrome. Dry, scaly skin, brittle nails, rashes, and hair loss are symptoms of malnutrition. Impaired absorption of nutrients from the GI tract is a sign of malabsorption syndrome.

The nurse is preparing a dietary plan for a patient whose body mass index is 15.5 kg/m 2. What should the nurse include in the plan? Select all that apply. a. Eating high-calorie foods b. Eating high-protein foods c. Initiating a weight-loss management program d. Avoiding the consumption of eggs e. Avoiding the consumption of dairy products

ANS: A B The patient's body mass index is 15.5 kg/m 2. A patient with a body mass index of less than 18.5 kg/m 2 is considered to be underweight. The patient needs food that is rich in proteins and calories. Eggs and dairy products are high in protein and should be recommended to the patient.

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

ANS: A B C EN is used with the patient who has a functioning GI tract but is unable to take any or enough oral nourishment, or when it is unsafe to do so. Indications for EN include persons with anorexia, orofacial fractures, head and neck cancer, extensive burns, or critical illness, and those receiving chemotherapy or radiation therapy. Common indications for parental nutrition (PN) include GI obstruction and short bowel syndrome. Crushing medications thoroughly and dissolving them in water will help prevent tube obstruction. The use of polyurethane or silicone feeding tubes helps decrease the risk of mucosal damage.

The nurse is caring for a patient who is suspected to be malnourished. What anthropometric measurements should the nurse assess? Select all that apply. a. Hip-to-waist ratio b. Midarm muscle circumference c. Skin fold thickness d. Height e. Waist circumference f. Chest circumference

ANS: A B C E Anthropometric measurements are gross measures of fat and muscle contents. They consist of measures of skin fold thickness at various sites, which are indicators of subcutaneous fat stores, and midarm muscle circumference, which is an indicator of protein stores. Hip-to-waist ratio and waist circumference are also anthropometric measurements. Such measurements are compared with the standards for healthy persons of the same age and gender. A person's height alone cannot indicate the malnutrition status. Chest circumference does not directly indicate malnutrition.

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

ANS: A B C E Handgrip strength is a measure of muscle strength that is used to assess the functional status, an important outcome of nutritional status. A diet history reflects food and nutrient intake and therefore helps to assess the nutritional status. Depression can affect intake of food and can lead to malnutrition. A consistent decrease in weight can lead to malnutrition; therefore, rate of weight change is an essential component of nutritional assessment. Serum albumin has a half-life of approximately 20 to 22 days. In the absence of marked fluid loss, such as from hemorrhage or burns, the serum albumin value lags behind the actual protein changes by more than 2 weeks. Therefore, albumin is not a good indicator of acute changes in nutritional status. WBC count does not directly indicate malnutrition.

The nurse should encourage which dietary habits for a healthy lifestyle? Select all that apply. a. A well-balanced diet b. Adequate intake of water c. Consumption of whole milk d. Intake of whole grains e. Consumption of preserved foods

ANS: A B D A well-balanced diet contains a sufficient number of calories to maintain a healthy weight. It acts as a first step in the process of a healthy lifestyle. Depending on changes in health status and daily activity level, calorie intake should be adjusted. Consumption of sugar-added beverages results in the increase of calorific value of the recommended dietary allowance. The beverages can be replaced by adequate intake of water to reduce the risk of excess calorie intake. Grains provide essential carbohydrates and polysaccharides. Whole milk contains more saturated fats, which affect calorie intake. Whole milk can be replaced by fat-free or low-fat (1%) milk. Preserved foods contain high levels of salts, resulting in the intake of sodium and altering caloric intake.

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

ANS: A B E PN may be the only feasible option for patients who do not have a functioning GI tract or who have disorders requiring complete bowel rest, such as some stages of ulcerative colitis, bowel obstruction, certain pediatric GI disorders (such as congenital GI anomalies, prolonged diarrhea regardless of its cause), and short bowel syndrome due to surgery. Head cancer is not an indication for PN. Facial swelling may or may not prevent a patient from consuming food through the oral route.

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

ANS: A B E The vital signs can be recorded along with measurement of height and weight. The previous diet history of the patient is assessed for management and recovery of the condition. The body mass index is calculated to assess whether the patient is underweight. X-ray studies and capnography are not required for the diagnosis of malnutrition. X-ray studies are used to assess tube position in enteral feedings. Capnography is used in monitoring of breath-to-breath carbon dioxide level to detect entry of tube into the trachea during insertion.

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

ANS: A B E Whole grains are better sources of fiber and other important nutrients, such as selenium, potassium, and magnesium, and therefore should be substituted for refined products. Oversized portions mean significant excess calorie intake, especially when eating high-calorie foods. Thus, foods should be portioned out before eating. Adding fruits as a part of the meal replaces unhealthy choices, and it adds much-needed nutrients and fiber. Sugary drinks, including many fruit juices, are high in calories and should be avoided. Pickled foods and cured meats contain high sodium levels and are not better sources of sodium than is table salt. Sodium attracts water, and a high-sodium diet draws water into the bloodstream, which increases the volume of blood and over time can increase the blood pressure. Therefore, lower-sodium versions of foods such as soups and breads should be chosen.

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

ANS: A C For the stable patient, the LPN/LVN can administer bolus or continuous feedings and administer medications through the gastrostomy. The RN must evaluate the nutritional status of the patient, monitor for complications related to the tube and the enteral feeding, and teach the caregiver about feeding via the gastrostomy tube at home.

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

ANS: A C E Daily D requirements are higher in older adults; therefore, a supplement should be provided. Some older persons may require parenteral nutritional support therapies until their strength and general health improve. In long-term care, oral liquid supplements may be used instead of water with oral medications to increase calorie intake. Nutritional supplements should not be used as meal substitutes but, rather, should be used between meals as snacks. Nutritional supplements do not provide all of the benefits of a complete meal. A moderate amount of high-quality protein at each meal is necessary to prevent loss of muscle mass and to maintain function.

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

ANS: B Central PN must be infused in a large central vein so rapid dilution can occur. Central PN is indicated when protein and caloric requirements are high. Central PN solutions are hypertonic, measuring at least 1600 mOsm/L. The glucose content ranges from 20% to 50%.

Using the Mini Nutritional Assessment (MNA), the nurse identifies an elderly patient as a nutritional risk. What is the next priority action? a. Use the Minimum Data Set (MDS) to obtain further information. b. Perform a full nutritional assessment. c. Notify the health care provider. d.Use the Outcome and Assessment Information Set (OASIS) to obtain further information.

ANS: B If screening identifies a person at nutritional risk, the nurse should perform a full nutritional assessment. Nutritional assessment provides the basis for nutritional intervention. The nurse should gather any data missing from the MNA. The MDS form is used to obtain initial nutritional information in a long-term care setting. The health care provider should be notified after a full nutritional assessment has been completed. The OASIS is used to obtain initial nutritional information in a home care setting.

The registered nurse provides information to a student nurse about tube feedings. Which statement made by the student nurse indicates the need for further teaching? a. "Gastric secretions can increase residual volume." b. "Gastric residual monitoring can be discontinued after consistently obtaining little or no residual amounts." c. "When residual volumes are consistently more than 500 mL, the feeding tube should be placed below the ligament of Treitz." d. "There should be no residual volume when enteral nutrition is delivered through a jejunostomy tube."

ANS: B Monitoring of residual volumes should continue as the patient condition may change, preventing the patient from digesting the amount being given. Gastric secretions can increase residual volumes. When gastric residual volumes consistently measure more than 500 mL, the feeding tube should be placed below the ligament of Treitz. Residual volumes should not be obtained when enteral nutrition is delivered through a jejunostomy tube.

An undernourished patient is admitted to the hospital with a gastrointestinal (GI) obstruction. What does the nurse anticipate will be prescribed to meet nutritional needs? a. Appetite stimulants b. Parenteral nutrition c. Enteral feedings d. Meal supplements

ANS: B Parenteral nutrition is used to meet a patient's nutritional needs in the case of a GI obstruction until the obstruction has been resolved. Appetite stimulants will not help the patient with a GI obstruction. Enteral feedings and meal supplements are contraindicated for patients who have GI obstructions.

How should the nurse position a patient who is receiving an enteral feeding through a small-bore nasogastric tube? a. Supine in bed b. Head of the bed elevated 45 degrees c. Head of the bed elevated 90 degrees d. Lying on the left side, head of the bed elevated 15 degrees

ANS: B Proper positioning is important for a patient with a small-bore nasogastric tube feeding to decrease the risk of aspiration. Elevate the head of the bed to a minimum of 30 degrees, but preferably 45 degrees, to prevent aspiration. Lying on the left side with the head of the bed elevated 15 degrees or lying supine places the patient at risk for aspiration. It is not necessary to elevate the head of the bed to 90 degrees, and may cause discomfort for the patient.

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

ANS: B Proteins are required for tissue growth, repair, and maintenance. Lean poultry is a good source of high-quality protein. Cooked fruits, raw vegetables, and white rice are not good sources of high-quality protein.

The nurse is educating a group of caregivers about tube feedings, including safety during administration of enteral feedings. Which instruction should be included? a. Lower the head of the bed during the tube feeding. b. Obtain radiographic confirmation of newly inserted tubes. c. Check gastric residual volumes hourly. d. After surgical placement of a gastrostomy tube, wait for flatus or a bowel movement before feeding.

ANS: B Radiographic confirmation should be obtained to determine if the blindly placed tube is properly positioned. Proper patient positioning decreases the risk of aspiration. Hence, the head of the bed should be elevated to a minimum of 30° to prevent aspiration. Gastric residual volumes should be checked every 4 hours during the first 48 hours for gastrically fed patients. Enteral feedings can be started within 24 to 48 hours after surgical placement of a gastrostomy tube, without waiting for flatus or a bowel movement.

The nurse should instruct a student nurse that a syringe will be needed for what type of enteral feeding? a. Cyclic feedings b. Intermittent bolus c. Continuous infusion d. Intermittent infusion

ANS: B The nurse or student nurse will provide an intermittent bolus delivery using a syringe. Cyclic feedings and continuous infusions utilize pumps for delivery. An intermittent infusion uses gravity for delivery.

A patient with dysphagia is receiving enteral feedings through a percutaneous endoscopic gastrostomy (PEG). What intervention should the nurse integrate into this patient's care? a. Flush the tube with 30 mL of normal saline every 4 hours b. Flush the tube before and after feedings if the patient's feedings are intermittent c. Flush the PEG with 100 mL of sterile water before and after medication administration d. To prevent fluid overload, avoid flushing when the patient is receiving continuous feeding

ANS: B The nurse should flush feeding tubes with 30 mL of water (not normal saline) every 4 hours and before and after medication administration during continuous feeding or before and after intermittent feeding. Flushes of 100 mL are excessive and may cause fluid overload in the patient.

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

ANS: B The use of PN necessitates frequent and thorough assessments. Key focuses of these assessments include daily weights and close monitoring of electrolyte levels. Refeeding syndrome is a complication associated with PN and is characterized by fluid retention and electrolyte imbalance. Assessments of bowel sounds, integument, peripheral vascular system, LOC, chest sounds, and blood coagulation may be performed, but close monitoring of fluid and electrolyte balance supersedes these in importance.

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

ANS: B When compared with central PN, PPN is less hypertonic. PPN has an osmolality of up to 800 mOsm/L. Central PN solutions measure at least 1600 mOsm/L. It is not necessary to question prescriptions of 30 mEq of potassium chloride, amino acids, or an infusion rate of 100mL/hr for a PPN.

As a result of refeeding syndrome, a patient experiences hypophosphatemia. The nurse should monitor the patient for what complications associated with the condition? Select all that apply. a. Lanugo b. Paresthesias c. Respiratory arrest d. Cardiac dysrhythmias e. Broken blood vessels in the eyes

ANS: B C D Hypophosphatemia is a sign of refeeding syndrome, which is associated with serious conditions such as paresthesias, respiratory arrest, and cardiac dysrhythmias. Lanugo is a manifestation of anorexia nervosa. Broken blood vessels in the eyes indicate bulimia nervosa.

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

ANS: B C E Hypophosphatemia is the hallmark of refeeding syndrome and is associated with serious outcomes, including cardiac dysrhythmias, respiratory arrest, and neurologic disturbances (e.g., paresthesias). Diarrhea, nausea, and vomiting are not commonly found in refeeding syndrome.

At 7:00 am, the nurse begins care of a patient who is receiving parenteral nutrition (PN). The last time the PN bag and tubing were changed was at 9:00 am the day before. The PN solution contains dextrose. What nursing interventions are needed to manage the patient's PN infusion? Select all that apply. a. Give the patient insulin. b. Check glucose blood levels every 4 to 6 hours. c. Verify that a subsequent bag has been prescribed. d. Ensure that the replacement solution is at room temperature by 9:00 am. e. Discontinue the PN solution and replace it with a new bag by 9:00 am.

ANS: B C E The nurse should check the patient's glucose blood levels at bedside every 4 to 6 hours with a glucose testing meter. The nurse should verify that the next bag has been prescribed to be sure the solution will not run out before the next bag is available. Discontinue the PN solution and replace it with a new solution if the bag is not empty at the end of 24 hours. The patient would only receive insulin if the patient is experiencing hyperglycemia and was receiving sliding scale insulin or had diabetes mellitus. At room temperature, the solution is a good medium for microorganism growth. In general, PN solutions are good for 24 hours and must be refrigerated until 30 minutes before use.

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

ANS: B D E Empting drainage devices and measuring output do not require nursing assessment and judgment and so can be delegated to unlicensed assistive personnel. Weighing the patient does not require specialized skills and can be delegated to unlicensed assistive personnel. Providing oral care to the patient with a nasogastric, gastrostomy, or jejunostomy tube is a simple and repetitive task. Therefore, it can be delegated to unlicensed assistive personnel. Removing the nasogastric tube and irrigating the nasogastric and gastrostomy tubes require nursing judgment and should not be delegated to unlicensed assistive personnel.

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

ANS: C A patient with iron deficiency should select cooked soybeans as a food that is high in iron. A cup of cooked soybeans contains 8.8 mg of iron. A cup of peanuts contains 6.4 mg of iron. Two eggs contain 2 mg of iron. Two slices of whole wheat bread contain 1 mg of iron.

The nurse provides care for a patient who has third-degree burns and a paralytic ileus. What type of intervention is appropriate for long-term support of nutrition for the patient? a. Oral nutrition b. Enteral nutrition c. Central parenteral nutrition d. Peripheral parenteral nutrition

ANS: C Central parenteral nutrition is administered when long-term support is required or when the patient has high protein and caloric requirements. Central parenteral nutrition is given through a central venous catheter that originates at the subclavian or jugular vein. Because the patient has paralytic ileus, oral and enteral nutrition are not possible. Peripheral parenteral nutrition is preferred for the short term and when protein and caloric requirements are not high.

The nurse collaborates with a patient to create a dietary plan. The patient reports being a strict follower of Muslim dietary traditions and beliefs. The nurse anticipates that the patient will make what type of food selections? a. The patient will select only soul foods. b. The patient will adhere to Kosher dietary practices. c. The patient will adhere to Halal dietary practices. d. The patient will observe a meatless diet and select vegetables only.

ANS: C Each culture has its own beliefs and behaviors related to food. Dietary plans should be adjusted based on an individual's cultural background. The nurse should assess the extent to which a Muslim patient adheres to Halal dietary practices to ensure that appropriate meals are served. Islam has specific laws regarding food, according to the Islamic Food and Nutrition Council of America. Soul food is traditional food eaten by some African Americans. Kosher food is traditional food eaten by Jewish people. Vegans eat only vegetables.

The nurse is caring for a patient with burn injuries who is also malnourished. The nurse notes that the patient's intravenous fat emulsion was recently discontinued. The nurse suspects that the action was taken because the patient is experiencing what condition? a. Pancreatitis b. Liver failure c. Hyperlipidemia d. Respiratory disease

ANS: C Patients with burn injuries may become malnourished because of their inability to digest a proper diet. As a result, nutrition is provided through the parenteral route. Fat emulsions are contraindicated in patients who have disturbances in fat metabolism, such as hyperlipidemia. These emulsions interfere with the metabolism of triglyceride hydrolysis, leading to aggravation of hyperlipidemia. Fat and lipid emulsions can be used cautiously in patients with pancreatitis, liver failure, and respiratory disease.

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

ANS: C Refeeding syndrome is characterized by respiratory distress, cardiac dysrhythmias, and neurologic disturbances such as paresthesias, which include burning and prickling sensations. Abdominal distention does not cause a burning or prickling sensation. The displacement of a catheter results in increased body temperature, pulse rate, and shortness of breath. Decreased serum levels of fat-soluble vitamins can lead to fatty stools, termed as steatorrhea.

The nurse is caring for a patient admitted to the hospital for asthma who weighs 186 lb (84.5 kg). During dietary counseling, the nurse should recommend that the patient's diet should include how many grams of protein? a. 24 b. 41 c. 75 d. 126

ANS: C The daily intake of protein should be between 0.8 and 1 g/kg of body weight. Thus, this patient should take in between 68 and 84 g of protein per day in the diet; 24 and 41 grams of protein are not enough and 126 grams of protein is too much.

The nurse is providing care for a patient who is a vegan. To prevent the consequences of iron deficiency, what should the nurse recommend? a. Brown rice b. Cauliflower c. Cooked soybeans d. Whole-grain bread

ANS: C Vegans are at a particular risk for iron deficiency, a problem that can be prevented by regularly consuming high-iron foods such as cooked soybeans. Brown rice, kidney beans, cauliflower, egg substitutes, whole grain bread, and citrus fruits are sources of iron but do not contain as much iron as soybeans.

While monitoring a patient who has a nasointestinal tube in place, the nurse observes an increase in gastric residual volume. What does the nurse suspect is the cause of the increased volume? a. Kinked tube b. Clogged tube c. Displacement of the tube d. Inappropriate size of the tube

ANS: C An increase in gastric residual volume indicates displacement of the nasointestinal tube. Tube kinking occurs because of vomiting or coughing. Tube clogging is observed when tubes are not flushed before and after administrating medication. The size of the tube does not cause a change in residual amounts.

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

ANS: C D E Improper administration of nutrients or lack of monitoring leads to metabolic disorders of parenteral nutrition. These include hypoglycemia, which is characterized by decreased levels of blood sugar; hyperglycemia, which is characterized by increased blood sugar levels; and hyperlipidemia, which is an indication of increased cholesterol levels in the blood. Phlebitis and dislodgment are catheter-related disorders of parenteral nutrition.

The nurse completes a nutritional screening and identifies that a patient is at risk for malnutrition. What is the next step for the nurse to take? a. Provide supplements between meals b. Encourage eating meals with others c. Have family members bring in food from home d. Complete a full nutritional assessment

ANS: D A full nutritional assessment includes history and physical examination and laboratory data. The nutritional assessment will need to be done to provide the basis for nutrition intervention. Supplements may be given if prescribed; the family bringing food from home and socializing with meals may be an option after a full nutritional assessment is done.

The nurse assesses an older patient in a clinic who reports unintended weight loss over the last 6 months. The nurse reviews documentation from the patient's previous visits and notes a consistent body weight of 160 pounds. For this patient, how much weight loss is a critical indicator for further assessment? a. More than 3 pounds b. More than 5 pounds c. More than 6 pounds d. More than 8 pounds

ANS: D A loss of more than 5% of the usual body weight over 6 months is a critical indicator for further assessment. The patient's usual body weight is 160 pounds. Five percent of the patient's weight is 8 pounds.

The nurse is educating a student nurse about enteral feedings that are administered through a nasogastric (NG) tube. What is appropriate for the nurse to include in the teaching about the NG tube? a. It is surgically inserted into the stomach. b. It is inserted through the nose into the jejunum. c. It is surgically inserted directly into the jejunum. d. It is inserted through the nose into the stomach.

ANS: D A nasogastric tube is inserted through the nose and goes to the stomach via the throat. The tube does not go all the way to the jejunum. The insertion of a nasogastric tube is not a surgical intervention.

The nurse recognizes that a primary deficiency for a patient that is a strict vegan is a lack of what? a. Vitamin E b. Vitamin A c. Vitamin K d. Vitamin B 12

ANS: D A primary deficiency for a strict vegan is a lack of cobalamin (vitamin B 12). Cobalamin is only obtained from animal protein, special supplements, or foods fortified with the vitamin. Vegans not using cobalamin supplements are susceptible to the development of megaloblastic anemia and the neurologic signs of cobalamin deficiency.

The registered nurse teaches a student nurse about enteral nutrition. Which statement made by the student nurse indicates the need for further teaching? a. "A nasogastric tube is used when there is a risk for aspiration with oral consumption." b. "A nasogastric tube is used when a patient needs short-term feeding." c. "A fluoroscopic procedure is used for the placement of a nasointestinal tube." d. "Enteral nutrition is given to patients with nonfunctional gastrointestinal tracts."

ANS: D Enteral nutrition is ordered for patients who have a functional gastrointestinal tract but who are unable to consume food orally. Nasogastric tubes are used in pathophysiologic conditions in which there is a risk for aspiration and they are used for short-term feeding. If the feedings are extended, then a fluoroscopic procedure is used for the placement of a nasointestinal tube.

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

ANS: D If a patient who is on tube feedings develops diarrhea, treatments include discontinuing excessive water boluses, diluting or decreasing the rate of feedings, and/or changing to continuous drip feedings. Increased rate of feedings, low-fiber formula, and contaminated formula (caused by not refrigerating unused formula) are causes of diarrhea.

A patient received a small-bore nasogastric (NG) tube after a laryngectomy. What should be the nurse's priority intervention before starting the enteral feeding? a. Aspirate gastric content b. Auscultate air c. Elevate the head of bed to 40 degrees d. Obtain x-ray confirmation of tube placement

ANS: D It is imperative to ensure that an NG tube is situated in the gastrointestinal (GI) tract rather than in the patient's lungs. When an NG tube has been inserted recently, it is important to confirm this placement with an x-ray that will identify the tube's radiopaque tip. Aspiration and air auscultation may not differentiate between gastric and respiratory placement of the tube. Elevating the head of bed at least 30 degrees prevents aspiration. To determine the maintenance of the feeding tube's proper position, the exit site of the tube is marked at the time of the x-ray and the external portion measured to allow for assessment of a changed position with a change in the length of the tube.

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

ANS: D Proper position of the patient reduces the risk of aspiration. The head of the bed should be elevated to a minimum of 45 degrees to prevent aspiration. Using a high-fiber formula helps to prevent constipation but does not protect from aspiration. Labeling or color-coding feeding tubes and connectors helps to decrease the risk of misconnections. Marking the exit site of the feeding tube is for observing a change in the external tube length during feedings.

The nurse is planning to administer enteral feedings to a patient with an orofacial fracture. How should the nurse position the patient after delivering a bolus feeding through the patient's nasogastric (NG) tube? a. Allow the patient to choose the position that provides the most comfort. b. Place the patient in the Trendelenburg position to reduce facial edema. c. Raise the head of the bed to 20 to 30 degrees for 2 hours after the feeding. d. Place the patient in the semi-Fowler's position for 30 to 60 minutes after the feeding.

ANS: D Raise the head of the bed to at least 30 to 45 degrees (semi-Fowler's position) to prevent aspiration. The head should remain elevated for 30 to 60 minutes after feeding. A position of comfort may not be the position that will prevent aspiration. The Trendelenburg position is used to elevate the foot of the bed; it will increase the risk of the patient aspirating. Raising the head of the bed to 20 to 30 degrees is not sufficient to prevent aspiration.

The nurse has inserted a nasogastric tube for a patient with suspected bowel obstruction. What is an appropriate nursing diagnosis? a. Risk for paralytic ileus b. Abdominal pain c. Impaired tissue perfusion t d. Risk for skin impairment

ANS: D With nasogastric tube placement, the patient is likely to breathe through the mouth and may experience irritation in the affected nares. The nurse should plan preventive measures by providing skin care around the insertion site and monitoring the skin for redness and maceration. The patient should not experience paralytic ileus, abdominal pain, or impaired tissue perfusion.