Chapter 36: Nutrition PrepU

A nurse is discussing neonatal care with a new mother. Which statement by the nurse best describes the value of breastfeeding?

"Breastfeeding provides the neonate with immunity against some bacteria and viruses." Explanation: Breast milk provides neonates with immunity against some bacteria and viruses, results in different intestinal flora than with artificial formula, decreases the incidence of allergies, and provides a well-balanced and ideal source of nutrition. Breastfeeding does help the mother bond with the neonate and is a complete source of nutrition. Reference: Chapter 36: Nutrition - Page 1290

At what period of life do nutrient needs stabilize?

Adulthood Explanation: Nutrient needs change across the life span in relation to growth, development, activity, and age. Periods of intense growth and development (such as during infancy, adolescence, pregnancy and lactation) increase nutrient needs. Nutrient needs stabilize during adulthood. Reference: Chapter 36: Nutrition - Page 1290

The nurse's assessment reveals that the client's gastrostomy tube feels slack and the site is leaking a significant amount of drainage. What should the nurse do?

Apply gentle pressure to the tube while pressing the external bumper closer to the skin. Explanation: If the gastrostomy tube is leaking large amounts of drainage the nurse should check the tension of tube. If there is a large amount of slack between the internal guard and the external bumper, drainage can leak from the site. The nurse should apply gentle pressure to the tube while pressing the external bumper closer to the skin. It is not necessary to remove the tube. Barrier cream and gauze will not necessarily resolve the problem. Reference: Chapter 36: Nutrition - Page 1330-1332

A nurse is teaching a client about diabetes and glucose monitoring. What should the nurse include in the teaching?

Blood from the fingertips shows changes in glucose more quickly than other testing sites. Explanation: With glucose monitoring, blood from the fingertips shows changes in blood glucose more quickly than other testing sites. With signs and symptoms of hypoglycemia, a fingertip site should be used. Calibrate the glucose monitors at least every month. Glucose levels increase with illness and stress to the body. Reference: Chapter 36: Nutrition - Page 1335

Which nursing action associated with successful tube feedings follows recommended guidelines?

Check the residual before each feeding or every 4 to 8 hours during a continuous feeding. Explanation: The nurse should check the residual before each feeding or every 4 to 8 hours during a continuous feeding. High gastric residual volumes (200 to 250 mL or greater) can be associated with high risk for aspiration and aspiration-related pneumonia. A closed system is the best way to prevent contamination during enteral feedings. The bowel sounds do not have to be assessed as often as 4 times per shift. Once a shift is sufficient. Food dye should not be added as a means to assess tube placement or potential aspiration of fluid. Reference: Chapter 36: Nutrition - Page 1307-1310

The nurse is preparing to administer an intermittent feeding to a client who has a feeding tube. The nurse is unable to aspirate gastric contents and realizes that the tube is clogged. Which action is correct?

Connect a syringe filled with warm water to the feeding tube and flush it out using gentle pressure. Explanation: Most obstructions are caused by coagulation of formula. The nurse should try using warm water and gentle pressure to remove the clog. Carbonated sodas, such as Coca-Cola, and meat tenderizers have not been shown effective in removing clogs in feeding tubes. Never use a stylet to unclog tubes. Advancing the tube is not needed, as this will not address the clog. Reference: Chapter 36: Nutrition - Page 1324-1330

Which method of feeding would a nurse normally provide if a client can attempt eating regular meals during the day and is prepared to ambulate and resume activities?

Cyclic feeding Explanation: Cyclic feeding allows the client to attempt eating regular meals during the day, if this is possible, making ambulation and activity easier. Intermittent feedings are the preferred method for gastric feeding. Intermittent feedings are delivered at regular intervals in equal portions, introducing the formula gradually over a set period of time via gravity or a feeding pump. Continuous feedings allow gradual introduction of the formula into the GI tract, promoting maximal absorption. They require use of an enteral feeding pump, which limits the client's mobility and increases cost. Reference: Chapter 36: Nutrition - Page 1310

An older adult client who has a BMI of 28.1 and gastroesophageal reflux disease (GERD) reports heartburn frequently. The nurse plans to teach the client how to manage and prevent heartburn. What information will the nurse include in the teaching for this client? Select all that apply.

Do not use products that contain nicotine, such as tobacco and vaping devices. Maintain a diet that is low in fat. Plan a nutritious diet that will allow you to lose weight. Explanation: When teaching a client who has GERD, the nurse will include the following information: no smoking, a diet low in fat, and lose weight. Nicotine in tobacco and vaping products lower esophageal sphincter pressure, allowing reflux of stomach contents into the esophagus. Fat in the diet delays emptying of the stomach and increases the likelihood of reflux. Being overweight (a BMI greater than 25) increases intra-abdominal pressure, pushing gastric contents into the esophagus. The client is instructed to raise the head of the bed 30 to 40 degrees. This means placing the legs of the head of the bed on blocks. Using two pillows causes a bend in the neck. Pillows do not raise the level of the esophagus. The client is also instructed to avoid eating before bedtime. Again, eating before bedtime allows for reflux. Alcohol relaxes the lower esophageal sphincter pressure and increases the production of gastric acid. Both of these physiologic actions allow for reflux. Reference: Chapter 36: Nutrition - Page 1302

A client has had a stroke and will require long-term tube feeding. Which type of feeding tubes would be most appropriate for this client's needs?

Gastrostomy tube Explanation: When enteral feeding is required for a long-term period, an enterostomal tube may be placed through an opening created into the stomach (gastrostomy) or into the jejunum (jejunostomy). NG, NI, and Salem Sump tubes will not meet a client's long-term nutritional needs. Reference: Chapter 36: Nutrition - Page 1330-1332

A nurse is learning about religious dietary restrictions at a nursing conference. Which religious meal selection should the nurse understand is appropriate?

Hindus: Vegetable plate Explanation: Dietary restrictions associated with religions are extremely important to provide culturally competent nursing care. Hindus do not consume beef because cows are considered a sacred creature. They are typically vegetarians; therefore, a vegetable plate is appropriate for this client. Orthodox Jews must have kosher foods. Shrimp and pork are prohibited in this religion. Mormons do not drink coffee, tea, or alcohol and they limit their meat consumption. Reference: Chapter 36: Nutrition - Page 1292

What is an appropriate intervention when unexpected situations occur during the administration of a tube feeding?

If the tube becomes clogged when aspirating contents, use warm water and gentle pressure to remove the clog. Explanation: Warm water and gentle pressure should be used to unclog a tube. If a large amount of residue is accidentally aspirated, the health care provider should be notified. If the client is nauseated, the head of the bed should remain elevated and an antiemetic administered as prescribed. The tube should be in the stomach, not the esophagus. Reference: Chapter 36: Nutrition - Page 1324-1329

A nurse is reviewing a client's laboratory values. Which laboratory value would be indicative of a client's level of malnutrition?

Serum albumin Serum albumin levels can help measure protein levels in the body and are good indicators for nutrition status. Hemoglobin levels maintain red blood cells that carry oxygen from the lungs to the body's tissues and returns carbon dioxide from the tissues back to the lungs. Creatinine is a laboratory value that assesses kidney function. Oxygen saturation is the fraction of oxygen-saturated hemoglobin relative to total hemoglobin in the blood. It is best used to determine how well a client is oxygenating.

A physician orders nutritional therapy administered via a central vein for a client who cannot take foods orally. What is the term for this type of nutrition?

Total parenteral nutrition (TPN) Explanation: TPN is nutritional therapy that bypasses the gastrointestinal tract and is administered through a central vein. PPN is nutritional therapy used for clients who have an inadequate oral intake and require supplementation of nutrients through a peripheral vein. A PEG is a surgically placed gastrostomy tube. A PEJ is a surgically placed jejunostomy tube. Reference: Chapter 36: Nutrition - Page 1315

A nurse is checking a client's capillary blood glucose level. Which nursing action is most appropriate?

Touch the test strip directly to a drop of blood The nurse should touch a drop of blood to pad to the test strip without smearing it. Test strips are not cleaned and blood flow is encouraged by warming or stroking the finger, not having the client make a fist. The site should not be wiped with alcohol after testing.

Which of the following is a fat-soluble vitamin?

Vitamin E Reference: Chapter 36: Nutrition - Page 1286

A client who has bleeding tendencies has a deficiency in which vitamin?

Vitamin K Vitamin K deficiencies are manifested in two ways: an increased tendency to hemorrhage and hemorrhagic disease of the newborn, which is common in premature or anoxic newborns.

The nurse is helping a client who eats a normal diet of 2000 calories daily to read a nutritional label on a box of cereal. Which nutrient does the nurse identify as appropriate for this client?

cholesterol less than 300 mg Daily values are calculated in percentages based on standards set for total fat, saturated fat, cholesterol, sodium, carbohydrate, and fiber in a 2000-cal diet. Total fat should be less than 65 g; saturated fat should be less than 20 g; cholesterol should be less than 300 mg; and sodium should be less than 2400 mg.

A postmenopausal client wishes to increase the amount of vitamin D that she consumes to help keep her bones strong. Which food will the nurse recommend?

milk Explanation: Milk contains vitamin D, which helps with the absorption of calcium and phosphorous. The other choices do not.

The nurse is teaching a community group about reading food labels. When teaching about avoidance of refined sugar, the nurse will teach people to avoid foods containing which ingredient(s)? Select all that apply.

molasses corn syrup corn sweetener brown sugar

An older adult client has a decubitus ulcer with drainage, dysphagia, and immobility. She consumes less than 300 calories per day and has a large amount of interstitial fluid. The client is in a state of:

negative nitrogen balance. Explanation: A negative nitrogen balance exists when excretion of nitrogen exceeds the intake. Reference: Chapter 36: Nutrition - Page 1285

The community nurse is educating client groups about nutrition. Which group does the nurse identify that will benefit most from nutritional counseling and intervention?

older adults living on a fixed income Older adults who are socially isolated or living on fixed incomes will benefit most from nutritional counseling and intervention. Other individuals are not at the same level of risk.

After a teaching session regarding dietary choices of carbohydrates, which client responses indicate correct understanding of the foods to limit in the diet? Select all that apply.

rice wheat germ corn on the cob apple Explanation: Sources of carbohydrates include cereals and grains such as rice, wheat and wheat germ, oats, barley, corn, and cornmeal; fruits and vegetables; and sweeteners. Lean red meat is a protein source versus a carbohydrate. Reference: Chapter 36: Nutrition - Page 1284