Chapter 29: Management of Clients with Malnutrition Nursing School Test Banks

Black & Hawks: Medical-Surgical Nursing, 8th Edition

Test Bank

Chapter 29: Management of Clients with Malnutrition

MULTIPLE CHOICE

1. The nurses action that will best prevent clogging of a gastric feeding tube is to

a.

adhere to the tube flushing protocol.

b.

apply intermittent suction.

c.

check tube placement every 4 hours.

d.

periodically reposition the tube.

ANS: A

Tubes of any diameter will clog without strict adherence to a flushing protocol. The other options do not contribute to keeping the tube from clogging.

DIF: Application/Applying REF: p. 585 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Managing Equipment

2. The nurse teaching a family member how to position a client who is to receive tube feedings would suggest

a.

allowing the client to assume a position of comfort during the feeding.

b.

elevating the head of the bed at least 45 degrees before the feeding.

c.

encouraging the client to move out of bed into a chair for the feeding.

d.

placing the client in a left side-lying position with the head of the bed flat.

ANS: B

The head must be elevated at least 45 degrees for 1 hour before and 1 hour after feeding. The upright position helps to reduce the possibility of aspiration.

DIF: Application/Applying REF: p. 584 OBJ: Intervention

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Complications from Diagnostic Tests/Treatments/Procedures

3. The nurse explains that in the administration of total parenteral nutrition (TPN), options for infusion do not include which of the following?

a.

Central venous access device inserted through the jugular vein

b.

Peripheral IV catheter in the back of the hand

c.

PICC line inserted peripherally and threaded to the subclavian vein

d.

Totally implanted ports or external tunneled central venous catheters

ANS: B

TPN is usually infused into the central venous circulation because peripheral vessels are too small to dilute the feeding, becoming inflamed. Good options include central venous access devices, PICC lines, tunneled central venous catheters, or implanted ports. A plain peripheral IV in the back of the hand would not be a suitable location.

DIF: Comprehension/Understanding REF: pp. 586-587 OBJ: Intervention

MSC: Physiological Integrity Pharmacological and Parenteral Therapies-Total Parenteral Nutrition

4. To help prevent hyperglycemia in a client receiving TPN, the nurse would

a.

administer the solution slowly.

b.

keep the infusion at room temperature.

c.

protect the solution from light.

d.

use an infusion pump.

ANS: D

TPN must be delivered using a pump to control the infusion rate accurately and to prevent the possibility of a bolus and consequent hyperglycemia.

DIF: Application/Applying REF: p. 587 OBJ: Intervention

MSC: Physiological Integrity Pharmacological and Parenteral Therapies-Total Parenteral Nutrition

5. The nurse can reduce the risk of access site infection in a client receiving TPN by

a.

adding antibiotics to the TPN fluid.

b.

changing the catheter every 48 hours.

c.

changing the transparent dressing every 72 hours.

d.

using a semipermeable dressing on the insertion site.

ANS: C

Prevention of catheter-related infections is key to successful TPN administration and is one of the TJC National Patient Safety Goals. Gauze dressings are changed every 48 hours and transparent dressings every 3 to 7 days, using strict aseptic technique and meticulous hand-washing.

DIF: Application/Applying REF: p. 588 OBJ: Intervention

MSC: Safe, Effective Care Environment Safety and Infection Control-Medical and Surgical Asepsis

6. A nurse is caring for several clients with small-bore feeding tubes and nasogastric (NG) tubes. Which of the following activities can the nurse delegate to the unlicensed assistive personnel?

a.

Assessing placement of the nasoenteric feeding tube

b.

Reattaching suction to a nasogastric tube after the client ambulates

c.

Refilling the tube-feeding bag for a small-bore gastrostomy tube

d.

Performing skin care at the exit site of a jejunostomy tube

ANS: D

Assessing placement of any tube is a nursing responsibility and is out of the scope of unlicensed assistive personnel (UAP). Reattaching suction after a clients NG tube has been disconnected requires verification of the pressure setting and cannot be delegated. Filling or refilling tube-feeding bags with formula is also a licensed nurses responsibility. An unlicensed assistive personnel can perform skin care at the tubes exit site if the nurse delegates this procedure and verifies that the UAP is qualified to do it.

DIF: Application/Applying REF: p. 586 OBJ: Intervention

MSC: Safe, Effective Care Environment Management of Care-Delegation

7. In the initial assessment of a client with bulimia, the nurse would inquire about

a.

binge-eating episodes.

b.

black, tarry stools.

c.

flatulence.

d.

hyperactivity.

ANS: A

Clinical manifestations of bulimia nervosa include episodes of binge eating followed by self-induced vomiting.

DIF: Application/Applying REF: p. 592 OBJ: Assessment

MSC: Psychosocial Integrity Psychosocial Adaptation-Psychopathology

8. A client who is diagnosed with bulimia would be most likely to manifest the psychosocial alteration of

a.

denial.

b.

depression.

c.

self-mutilation.

d.

social withdrawal.

ANS: B

Personality characteristics typical of clients with bulimia are related to depression.

DIF: Knowledge/Remembering REF: pp. 592-593 OBJ: Assessment

MSC: Psychosocial Integrity Psychosocial Adaptation-Psychopathology

9. After discussing reasonable weight loss goals with a client, the nurse would see the need for further teaching with the clients statement

a.

I will limit my intake to 500 calories a day.

b.

I will try to eat very slowly.

c.

Ill try to pick foods from all five food groups.

d.

Its important to begin a regular exercise program.

ANS: A

A balanced diet with a daily deficit of 500-1000 kcal less than total daily energy expenditure is regarded as the most successful approach to losing 1-2 pounds per week. An exercise program should be part of the overall care of the obese client. Clients should eat a balanced diet with foods from the five food groups.

DIF: Evaluation/Evaluating REF: p. 591 OBJ: Evaluation

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Lifestyle Choices

10. The nurse preparing a postoperative teaching plan for a client who had a gastric stapling would include that

a.

dumping syndrome is a common side effect.

b.

fluids must be taken in liberal amounts.

c.

exercise is prohibited after meals.

d.

small, frequent feedings must become a habit.

ANS: D

Diet instructions must be part of the postoperative care, focusing on the frequency and size of meals. The client will also need to take a chewable or liquid multi-vitamin supplement each day.

DIF: Application/Applying REF: p. 591 OBJ: Intervention

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Self Care

11. The client manifestation noted by the nurse as inconsistent with malnutrition is

a.

constipation.

b.

delayed wound healing.

c.

fatigue.

d.

postural hypotension.

ANS: A

Diarrhea is a manifestation of the effects malnutrition has on gastrointestinal function.

DIF: Comprehension/Understanding REF: p. 574 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

12. The nurse explains to a client with renal failure who requires an oral nutritional supplement that the most appropriate brand would be

a.

Boost Plus.

b.

Nepro.

c.

Nutra Shake.

d.

Probalance.

ANS: B

Nepro is specialized for clients with renal failure who are receiving dialysis; it is low in electrolytes and volume.

DIF: Comprehension/Understanding REF: p. 581 OBJ: Intervention

MSC: Physiological Integrity Basic Care and Comfort-Nutrition and Oral Hydration

13. The nurse should assist the malnourished client with oral hygiene by providing the client with

a.

a firm-bristled toothbrush.

b.

alcohol-containing mouthwashes.

c.

glycerin and lemon swabs.

d.

warm saltwater rinses.

ANS: D

Routine mouth care should include (a) cleansing the mouth after each meal and at bedtime, (b) using a soft-bristle toothbrush, (c) rinsing with warm saltwater, and (d) avoiding alcohol-containing mouthwash or glycerin and lemon juice because they are drying to mucus membranes.

DIF: Application/Applying REF: p. 578 OBJ: Intervention

MSC: Physiological Integrity Basic Care and Comfort-Personal Hygiene

14. In feeding a client with a cognitive impairment, the least helpful nursing action is to

a.

create a quiet, unhurried environment.

b.

distract the client with conversation.

c.

orient the client to the feeding equipment.

d.

provide several small meals.

ANS: B

The nurse should only provide frequent cues to the client (e.g., Mrs. S, pick up the toast. or Mr. S, chew the food in your mouth.). A pleasant environment is quiet and unhurried. Explain the equipment you may be using. Extraneous conversation or other distractions from the meal should be avoided.

DIF: Application/Applying REF: pp. 578-579 OBJ: Intervention

MSC: Psychosocial Integrity Psychosocial Adaptation-Sensory/Perceptual Alterations

15. When assisting a dysphagic client to eat, the nurse should

a.

have the client slightly flex the neck for swallowing.

b.

place the client in Sims position for 15 minutes after meals.

c.

position the client in the semi-Fowler position.

d.

use the fingers to check the clients mouth for food.

ANS: A

Slightly flexing the head forward may aid in swallowing. A high-Fowler position with 90-degree flexion of the hips is usually the best position for mealtime. Maintaining the high-Fowler position for at least 30 minutes after a meal helps reduce reflux and aspiration. For safety, the nurse should never place unprotected fingers in the clients mouth when teeth or dentures are in place.

DIF: Application/Applying REF: pp. 579, 580 OBJ: Intervention

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Complications from Surgical Procedures and Health Alteration

16. Before administering enteral feeding, the nurse can ensure proper tube placement by

a.

asking the client to swallow.

b.

auscultating the stomach as 10 ml of water is injected.

c.

extracting stomach contents from the tube.

d.

holding the end of the tube under water to check for bubbling.

ANS: C

The confirmation of stomach contents is the best indication that the feeding tube is still in place. Auscultation is the least reliable method and is no longer recommended. GI contents, if obtained, can be checked for pH if this is part of the policy in your facility. Holding the end of the tube under water can cause aspiration and should never be done. Having the client swallow will not provide any accurate information about tube location.

DIF: Application/Applying REF: p. 584 OBJ: Assessment

MSC: Safe, Effective Care Environment Safety and Infection Control-Safe Use of Equipment

17. A client who has begun receiving TPN with lipids develops shaking chills, shortness of breath, and chest pain. The priority action by the nurse is to immediately

a.

call the physician.

b.

obtain a 12-lead ECG.

c.

stop the infusion.

d.

take a set of vitals.

ANS: C

Although rare, allergic reactions to intravenous lipid preparations have been reported and usually present within 30 minutes. Clinical manifestations of reactions can include fever, shaking chills, shortness of breath, chest pain, or back pain. When this occurs, the nurse must first stop the infusion before doing anything else.

DIF: Analysis/Analyzing REF: pp. 587-588 OBJ: Intervention

MSC: Safe, Effective Care Environment Management of Care-Establishing Priorities

18. The nurse providing instructions to a client who will be discharged to home with self-administered bolus enteral feedings would teach the client to infuse the feeding over

a.

2 to 10 minutes.

b.

10 to 15 minutes.

c.

15 to 30 minutes.

d.

30 to 60 minutes.

ANS: B

Bolus feedings are usually delivered over 10 to 15 minutes.

DIF: Comprehension/Understanding REF: p. 583 OBJ: Intervention

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Self Care

19. At 8 AM a nurse hangs a bag containing enteral nutrition formula for a client. The nurse will return at

a.

9 AM to change the tubing and bag and add new formula.

b.

10 AM to discard remaining formula and replace it with new.

c.

12 noon to replace formula after rinsing the bag and tubing.

d.

1 PM to flush the bag and tubing and add formula.

ANS: C

Formulas administered through an open delivery system should hang for only 4 hours before being changed and having the tubing flushed or rinsed. The entire equipment set should be changed every 24 hours. These open delivery systems are more vulnerable to contamination because of the amount of manipulation that occurs in their handling.

DIF: Application/Applying REF: p. 585 OBJ: Intervention

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Complications of Diagnostic Tests/Treatments/Procedures

20. A client with anorexia nervosa has a nursing diagnosis of Imbalanced Nutrition: Less than Body Requirements related to inadequate food intake. The clients current weight is 92 pounds. The nurse would evaluate that the client is making safe progress if the weight after 1 week is

a.

107 pounds.

b.

102 pounds.

c.

97 pounds.

d.

94 pounds.

ANS: D

Clients with severe nutritional depletion will be able to regain weight at a safe rate (1 to 2 pounds/week).

DIF: Evaluation/Evaluating REF: p. 593 OBJ: Evaluation

MSC: Physiological Integrity Physiological Adaptation-Illness Management

MULTIPLE RESPONSE

1. When planning care for the client with obesity who is having a gastric restrictive procedure, the nurse would include interventions designed to (Select all that apply)

a.

encourage the client to lose 4-6 pounds a week.

b.

ensure client and nurse safety.

c.

monitor the client while taking weight loss medication.

d.

prevent wound and skin complications.

ANS: B, D

To ensure safety, oversized equipment may be needed for the client who is obese, including scales, wheelchairs, bed, and other supplies like blood pressure cuffs. Skin management is a major concern as these clients have a higher incidence of skin problems and wound healing problems. Clients who are having surgical management of their obesity have not been successful with other weight loss regimens, including medications. Generally, 30% of the clients presenting weight is lost in the first year after surgery.

DIF: Application/Applying REF: pp. 590-591 OBJ: Intervention

MSC: Safe, Effective Care Environment Safety and Infection Control-Injury Prevention

Elsevier items and derived items 2009 by Saunders, an imprint of Elsevier Inc.

Some material was previously published.

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