Chapter 40: Nursing Management: Nutritional Problems Nursing School Test Banks

Chapter 40: Nursing Management: Nutritional Problems

Test Bank

MULTIPLE CHOICE

1. Which finding for a 19-year-old female who is a vegan may indicate the need for cobalamin supplementation?

a.

Paresthesias

b.

Ecchymoses

c.

Dry, scaly skin

d.

Gingival swelling

ANS: A

Cobalamin (vitamin B12) cannot be obtained from foods of plant origin, so the patient will be most at risk for signs of cobalamin deficiency, such as paresthesias, peripheral neuropathy, and anemia. The other symptoms listed are associated with other nutritional deficiencies but would not be associated with a vegan diet.

DIF: Cognitive Level: Apply (application) REF: 889

TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

2. A 76-year-old woman with a body mass index (BMI) of 17 kg/m2 and a low serum albumin level is being admitted by the nurse. Which assessment finding will the nurse expect to find?

a.

Restlessness

b.

Hypertension

c.

Pitting edema

d.

Food allergies

ANS: C

Edema occurs when serum albumin levels and plasma oncotic pressure decrease. The blood pressure and level of consciousness are not directly affected by malnutrition. Food allergies are not an indicator of nutritional status.

DIF: Cognitive Level: Apply (application) REF: 892

TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

3. Which menu choice indicates that the patient is implementing plans to choose high-calorie, high-protein foods?

a.

Baked fish with applesauce

b.

Beef noodle soup and canned corn

c.

Fresh fruit salad with yogurt topping

d.

Fried chicken with potatoes and gravy

ANS: D

Foods that are high in calories include fried foods and those covered with sauces. High protein foods include meat and dairy products. The other choices are lower in calories and protein.

DIF: Cognitive Level: Apply (application) REF: 895

TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity

4. A 48-year-old woman has a body mass index (BMI) of 31 kg/m2, a normal C-reactive protein level, and low serum transferrin and albumin levels. The nurse will plan patient teaching to increase the patients intake of foods that are high in

a.

iron.

b.

protein.

c.

calories.

d.

carbohydrate.

ANS: B

The patients C-reactive protein and transferrin levels indicate low protein stores. The BMI is in the obese range, so increasing caloric intake is not indicated. The data do not indicate a need for increased carbohydrate or iron intake.

DIF: Cognitive Level: Apply (application) REF: 892

TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity

5. A 48-year-old man who has just been started on tube feedings of full-strength formula at 100 mL/hr has 6 diarrhea stools the first day. Which action should the nurse plan to take?

a.

Slow the infusion rate of the tube feeding.

b.

Check gastric residual volumes more frequently.

c.

Change the enteral feeding system and formula every 8 hours.

d.

Discontinue administration of water through the feeding tube.

ANS: A

Loose stools indicate poor absorption of nutrients and indicate a need to slow the feeding rate or decrease the concentration of the feeding. Water should be given when patients receive enteral feedings to prevent dehydration. When a closed enteral feeding system is used, the tubing and formula are changed every 24 hours. High residual volumes do not contribute to diarrhea.

DIF: Cognitive Level: Apply (application) REF: 899

TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity

6. A 20-year-old man with extensive facial injuries from a motor vehicle crash is receiving tube feedings through a percutaneous endoscopic gastrostomy (PEG). Which action will the nurse include in the plan of care?

a.

Keep the patient positioned on the left side.

b.

Check the gastric residual volume every 4 to 6 hours.

c.

Avoid giving bolus tube feedings through the PEG tube.

d.

Obtain a daily abdominal x-ray to verify tube placement.

ANS: B

The gastric residual volume is assessed every 4 to 6 hours to decrease the risk for aspiration. The patient does not need to be positioned on the left side. Bolus feedings can be administered through a PEG tube. An x-ray is obtained immediately after placement of the PEG tube to check position, but daily x-rays are not needed.

DIF: Cognitive Level: Apply (application) REF: 898

TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity

7. A malnourished patient is receiving a parenteral nutrition (PN) infusion containing amino acids and dextrose from a bag that was hung 24 hours ago. The nurse observes that about 50 mL remain in the PN container. Which action is best for the nurse to take?

a.

Ask the health care provider to clarify the written PN order.

b.

Add a new container of PN using the current tubing and filter.

c.

Hang a new container of PN and change the IV tubing and filter.

d.

Infuse the remaining 50 mL and then hang a new container of PN.

ANS: B

All PN solutions are changed at 24 hours. PN solutions containing dextrose and amino acids require a change in tubing and filter every 72 hours rather than daily. Infusion of the additional 50 mL will increase patient risk for infection. Changing the IV tubing and filter more frequently than required will unnecessarily increase costs. The nurse (not the health care provider) is responsible for knowing the indicated times for tubing and filter changes.

DIF: Cognitive Level: Apply (application) REF: eTable 40-8

TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

8. A patients capillary blood glucose level is 120 mg/dL 6 hours after the nurse initiated a parenteral nutrition (PN) infusion. The most appropriate action by the nurse is to

a.

obtain a venous blood glucose specimen.

b.

slow the infusion rate of the PN infusion.

c.

recheck the capillary blood glucose in 4 to 6 hours.

d.

notify the health care provider of the glucose level.

ANS: C

Mild hyperglycemia is expected during the first few days after PN is started and requires ongoing monitoring. Because the glucose elevation is small and expected, notification of the health care provider is not necessary. There is no need to obtain a venous specimen for comparison. Slowing the rate of the infusion is beyond the nurses scope of practice and will decrease the patients nutritional intake.

DIF: Cognitive Level: Apply (application) REF: eTable 40-8

TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

9. After abdominal surgery, a patient with protein calorie malnutrition is receiving parenteral nutrition (PN). Which is the best indicator that the patient is receiving adequate nutrition?

a.

Serum albumin level is 3.5 mg/dL.

b.

Fluid intake and output are balanced.

c.

Surgical incision is healing normally.

d.

Blood glucose is less than 110 mg/dL.

ANS: C

Because poor wound healing is a possible complication of malnutrition for this patient, normal healing of the incision is an indicator of the effectiveness of the PN in providing adequate nutrition. Blood glucose is monitored to prevent the complications of hyperglycemia and hypoglycemia, but it does not indicate that the patients nutrition is adequate. The intake and output will be monitored, but do not indicate that the PN is effective. The albumin level is in the low-normal range but does not reflect adequate caloric intake, which is also important for the patient.

DIF: Cognitive Level: Apply (application) REF: 892

TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity

10. A 60-year-old man who is hospitalized with an abdominal wound infection has only been eating about 50% of meals and states, Nothing on the menu sounds good. Which action by the nurse will be most effective in improving the patients oral intake?

a.

Order six small meals daily.

b.

Make a referral to the dietitian.

c.

Teach the patient about high-calorie foods.

d.

Have family members bring in favorite foods.

ANS: D

The patients statement that the hospital foods are unappealing indicates that favorite home-cooked foods might improve intake. The other interventions may also help improve the patients intake, but the most effective action will be to offer the patient more appealing foods.

DIF: Cognitive Level: Apply (application) REF: 895

TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

11. When caring for a 63-year-old woman with a soft, silicone nasogastric tube in place for enteral feedings, the nurse will

a.

avoid giving medications through the feeding tube.

b.

flush the tubing after checking for residual volumes.

c.

administer continuous feedings using an infusion pump.

d.

replace the tube every 3 days to avoid mucosal damage.

ANS: B

The soft silicone feeding tubes are small in diameter and can easily become clogged unless they are flushed after the nurse checks the residual volume. Either intermittent or continuous feedings can be given. The tubes are less likely to cause mucosal damage than the stiffer polyvinyl chloride tubes used for nasogastric suction and do not need to be replaced at certain intervals. Medications can be given through these tubes, but flushing after medication administration is important to avoid clogging.

DIF: Cognitive Level: Apply (application) REF: 898

TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

12. A patient is receiving continuous enteral nutrition through a small-bore silicone feeding tube. What should the nurse plan for when this patient has a computed tomography (CT) scan ordered?

a.

Shut the feeding off 30 to 60 minutes before the scan.

b.

Ask the health care provider to reschedule the CT scan.

c.

Connect the feeding tube to continuous suction during the scan.

d.

Send the patient to CT scan with oral suction in case of aspiration.

ANS: A

The tube feeding should be shut off 30 to 60 minutes before any procedure requiring the patient to lie flat. Because the CT scan is ordered for diagnosis of patient problems, rescheduling is not usually an option. Prevention, rather than treatment, of aspiration is needed. Small-bore feeding tubes are soft and collapse easily with aspiration or suction, making nasogastric suction of gastric contents unreliable.

DIF: Cognitive Level: Apply (application) REF: 899

TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity

13. A healthy 28-year-old woman patient who weighs 145 pounds (66 kg) asks the nurse about the minimum daily requirement for protein. How many grams of protein will the nurse recommend?

a.

53

b.

66

c.

75

d.

98

ANS: A

The recommended daily protein intake is 0.8 to 1 g/kg of body weight, which for this patient is 66 kg 0.8 g = 52.8 or 53 g/day.

DIF: Cognitive Level: Apply (application) REF: 888

TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance

14. A 20-year-old female is being admitted for electrolyte disorders of unknown etiology. Which assessment finding is most important to report to the health care provider?

a.

The patient uses laxatives daily.

b.

The patients knuckles are macerated.

c.

The patients serum potassium level is 2.9 mEq/L.

d.

The patient has a history of large weight fluctuations.

ANS: C

The low serum potassium level may cause life-threatening cardiac dysrhythmias, and potassium supplementation is needed rapidly. The other information will also be reported because it suggests that bulimia may be the etiology of the patients electrolyte disturbances, but it does not suggest imminent life-threatening complications.

DIF: Cognitive Level: Apply (application) REF: 903

OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment

MSC: NCLEX: Physiological Integrity

15. Which action for a patient receiving tube feedings through a percutaneous endoscopic gastrostomy (PEG) may be delegated to a licensed practical/vocational nurse (LPN/LVN)?

a.

Providing skin care to the area around the tube site

b.

Teaching the patient how to administer tube feedings

c.

Determining the need for adding water to the feedings

d.

Assessing the patients nutritional status at least weekly

ANS: A

LPN/LVN education and scope of practice include actions such as dressing changes and wound care. Patient teaching and complex assessments (such as patient nutrition and hydration status) require registered nurse (RN)level education and scope of practice.

DIF: Cognitive Level: Apply (application) REF: 900

OBJ: Special Questions: Delegation TOP: Nursing Process: Planning

MSC: NCLEX: Safe and Effective Care Environment

16. Which action should the nurse take first when preparing to teach a frail 79-year-old Hispanic man who lives with an adult daughter about ways to improve nutrition?

a.

Ask the daughter about the patients food preferences.

b.

Determine who shops for groceries and prepares the meals.

c.

Question the patient about how many meals per day are eaten.

d.

Assure the patient that culturally preferred foods will be included.

ANS: B

The family member who shops for groceries and cooks will be in control of the patients diet, so the nurse will need to ensure that this family member is involved in any teaching or discussion about the patients nutritional needs. The other information will also be assessed and used but will not be useful in meeting the patients nutritional needs unless nutritionally appropriate foods are purchased and prepared.

DIF: Cognitive Level: Apply (application) REF: 890

OBJ: Special Questions: Prioritization TOP: Nursing Process: Planning

MSC: NCLEX: Health Promotion and Maintenance

17. After change-of-shift report, which patient will the nurse assess first?

a.

A 40-year-old woman whose parenteral nutrition infusion bag has 30 minutes of solution left

b.

A 40-year-old man with continuous enteral feedings who has developed pulmonary crackles

c.

A 30-year-old man with 4+ generalized pitting edema and severe protein-calorie malnutrition

d.

A 30-year-old woman whose gastrostomy tube is plugged after crushed medications were administered.

ANS: B

The patient data suggest aspiration has occurred and rapid assessment and intervention are needed. The other patients should also be assessed as quickly as possible, but the data about them do not suggest any immediately life-threatening complications.

DIF: Cognitive Level: Apply (application) REF: 899

OBJ: Special Questions: Prioritization; Multiple Patients TOP: Nursing Process: Planning

MSC: NCLEX: Safe and Effective Care Environment

18. A patient hospitalized with chronic heart failure eats only about 50% of each meal and reports feeling too tired to eat. Which action should the nurse take first?

a.

Teach the patient about the importance of good nutrition.

b.

Serve multiple small feedings of high-calorie, high-protein foods.

c.

Obtain an order for enteral feedings of liquid nutritional supplements.

d.

Consult with the health care provider about providing parenteral nutrition (PN).

ANS: B

Eating small amounts of food frequently throughout the day is less fatiguing and will improve the patients ability to take in more nutrients. Teaching the patient may be appropriate, but will not address the patients inability to eat more because of fatigue. Tube feedings or PN may be needed if the patient is unable to take in enough nutrients orally, but increasing the oral intake should be attempted first.

DIF: Cognitive Level: Apply (application) REF: 896

OBJ: Special Questions: Prioritization TOP: Nursing Process: Planning

MSC: NCLEX: Physiological Integrity

19. A patients peripheral parenteral nutrition (PN) bag is nearly empty and a new PN bag has not arrived yet from the pharmacy. Which intervention is the priority?

a.

Monitor the patients capillary blood glucose until a new PN bag is hung.

b.

Flush the peripheral line with saline and wait until the new PN bag is available.

c.

Infuse 5% dextrose in water until the new PN bag is delivered from the pharmacy.

d.

Decrease the rate of the current PN infusion to 10 mL/hr until the new bag arrives.

ANS: C

To prevent hypoglycemia, the nurse should infuse a 5% dextrose solution until the next PN bag can be started. Decreasing the rate of the ordered PN infusion is beyond the nurses scope of practice. Flushing the line and then waiting for the next bag may lead to hypoglycemia. Monitoring the capillary blood glucose is appropriate but is not the priority.

DIF: Cognitive Level: Apply (application) REF: 901

OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation

MSC: NCLEX: Physiological Integrity

20. A 19-year-old female admitted with anorexia nervosa is 5 ft 6 in (163 cm) tall and weighs 88 pounds (41 kg). Laboratory tests reveal hypokalemia and iron-deficiency anemia. Which nursing diagnosis has the highest priority?

a.

Risk for activity intolerance related to anemia

b.

Risk for electrolyte imbalance related to eating patterns

c.

Ineffective health maintenance related to body image obsession

d.

Imbalanced nutrition: less than body requirements related to anorexia

ANS: B

The patients hypokalemia may lead to life-threatening cardiac dysrhythmias. The other diagnoses are also appropriate for this patient but are not associated with immediate risk for fatal complications.

DIF: Cognitive Level: Apply (application) REF: 903

OBJ: Special Questions: Prioritization TOP: Nursing Process: Diagnosis

MSC: NCLEX: Physiological Integrity

21. The nurse is planning care for a patient who is chronically malnourished. Which action is appropriate for the nurse to delegate to unlicensed assistive personnel (UAP)?

a.

Assist the patient to choose high-nutrition items from the menu.

b.

Monitor the patient for skin breakdown over the bony prominences.

c.

Offer the patient the prescribed nutritional supplement between meals.

d.

Assess the patients strength while ambulating the patient in the room.

ANS: C

Feeding the patient and assisting with oral intake are included in UAP education and scope of practice. Assessing the patient and assisting the patient in choosing high-nutrition foods require licensed practical/vocational nurse (LPN/LVN)or registered nurse (RN)level education and scope of practice.

DIF: Cognitive Level: Apply (application) REF: 15-16

OBJ: Special Questions: Delegation TOP: Nursing Process: Planning

MSC: NCLEX: Safe and Effective Care Environment

22. A severely malnourished patient reports that he is Jewish. The nurses initial action to meet his nutritional needs will be to

a.

have family members bring in food.

b.

ask the patient about food preferences.

c.

teach the patient about nutritious Kosher foods.

d.

order nutrition supplements that are manufactured Kosher.

ANS: B

The nurses first action should be further assessment whether or not the patient follows any specific religious guidelines that impact nutrition. The other actions may also be appropriate, based on the information obtained during the assessment.

DIF: Cognitive Level: Apply (application) REF: 889

OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment

MSC: NCLEX: Psychosocial Integrity

MULTIPLE RESPONSE

1. Which of the nurses assigned patients should be referred to the dietitian for a complete nutritional assessment (select all that apply)?

a.

A 23-year-old who has a history of fluctuating weight gains and losses

b.

A 35-year-old who complains of intermittent nausea for the past 2 days

c.

A 64-year-old who is admitted for dbridement of an infected surgical wound

d.

A 52-year-old admitted with chest pain and possible myocardial infarction (MI)

e.

A 48-year-old with rheumatoid arthritis who takes prednisone (Deltasone) daily

ANS: A, C, E

Weight fluctuations, use of corticosteroids, and draining or infected wounds all suggest that the patient may be at risk for malnutrition. Patients with chest pain or MI are not usually poorly nourished. Although vomiting that lasts 5 days places a patient at risk, nausea that has persisted for 2 days does not always indicate poor nutritional status or risk for health problems caused by poor nutrition.

DIF: Cognitive Level: Apply (application) REF: 893

OBJ: Special Questions: Multiple Patients

TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

OTHER

1. The nurse is caring for a 47-year-old female patient who is comatose and is receiving continuous enteral nutrition through a soft nasogastric tube. The nurse notes the presence of new crackles in the patients lungs. In which order will the nurse take action? (Put a comma and a space between each answer choice [A, B, C, D].)

a. Check the patients oxygen saturation.

b. Notify the patients health care provider.

c. Measure the tube feeding residual volume.

d. Stop administering the continuous feeding.

ANS:

D, A, C, B

The assessment data indicate that aspiration may have occurred, and the nurses first action should be to turn off the tube feeding to avoid further aspiration. The next action should be to check the oxygen saturation because this may indicate the need for immediate respiratory suctioning or oxygen administration. The residual volume should be obtained because it provides data about possible causes of aspiration. Finally, the health care provider should be notified and informed of all the assessment data the nurse has just obtained.

DIF: Cognitive Level: Apply (application) REF: 899

OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation

MSC: NCLEX: Physiological Integrity

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