Chapter 45: Nutrition
MULTIPLE CHOICE
1. A nurse is teaching about the energy needed at rest to maintain life-sustaining activities for a specific period of time. What form of energy is the nurse discussing?
a. Resting energy expenditure (REE)
b. Basal metabolic rate (BMR)
c. Nutrient density
d. Nutrients
Answer: B: Basal metabolic rate (BMR)
The basal metabolic rate (BMR) is the energy needed at rest to maintain life-sustaining activities for a specific period of time. The resting energy expenditure (REE), or resting metabolic rate, is the amount of energy an individual needs to consume over a 24-hour period for the body to maintain all of its internal working activities while at rest. Nutrients are the elements necessary for body processes and function. Nutrient density is the proportion of essential nutrients to the number of kilocalories. High–nutrient density
foods provide a large number of nutrients in relation to kilocalories.
2. In general, when a patient’s energy requirements are completely met by kilocalorie (kcal) intake in food, which assessment finding will the nurse observe?
a. Weight increases.
b. Weight decreases.
c. Weight does not change.
d. Weight fluctuates daily.
ANSWER: C: Weight does not change.
In general, when energy requirements are completely met by kilocalorie (kcal) intake in food, weight does not change. When kilocalories are ingested, exceed a person’s energy demands, the individual gains weight. If kilocalories ingested fail to meet a person’s energy requirement, the individual loses weight. Fluid, not kilocalories, causes daily weight fluctuations.
3. A nurse is asked how many kcal/g are provided by fats. How should the nurse answer?
a. 3
b. 4
c. 6
d. 9
ANS: D: 9
Fats (lipids) are the most calorie-dense nutrient, providing 9 kcal/g. Carbohydrates and protein provide 4 kcal/g. DIF: Understand (comprehension)
OBJ: List the end products of carbohydrate, protein, and fat metabolism.
TOP: Implementation MSC: Physiological Adaptation
4. A nurse is teaching a patient about proteins that must be obtained through the diet since they cannot be synthesized in the body. Which term used by the patient indicates teaching is successful?
a. Amino acids
b. Triglycerides
c. Dispensable amino acids
d. Indispensable amino acids
ANS: D: Indispensable amino acids
The body does not synthesize indispensable amino acids, so these need to be provided in the diet. The simplest form of protein is the amino acid. The body synthesizes dispensable amino acids. Triglycerides are made up of three fatty acids attached to a glycerol.
5. A nurse is caring for a patient with a post-surgical wound. When planning care, which goal will be the priority?
a. Reduce dependent nitrogen balance.
b. Maintain negative nitrogen balance.
c. Promote positive nitrogen balance.
d. Facilitate neutral nitrogen balance.
ANSWER: C: Promote positive nitrogen balance.
When the intake of nitrogen is greater than output, the body is in a positive nitrogen balance. Positive nitrogen balance is required for growth, normal pregnancy, maintenance of lean muscle mass and vital organs, and wound healing. Negative nitrogen balance occurs when the body loses more nitrogen than the body gains. Neutral nitrogen balance occurs when gain equals loss and is not optimal for tissue healing. There is no such term as dependent nitrogen balance.
6. In providing diet education for a patient on a low-fat diet, which information is important for the nurse to share?
a. Polyunsaturated fats should be less than 7% of the total calories.
b. Trans fat should be less than 7% of the total calories.
c. Unsaturated fats are found mostly in animal sources.
d. Saturated fats are found mostly in animal sources.
ANS: D: Saturated fats are found mostly in animal sources.
Most animal fats have high proportions of saturated fatty acids, whereas vegetable fats have higher amounts of unsaturated and
polyunsaturated fatty acids. Linoleic acid, an unsaturated fatty acid, is the only essential fatty acid in humans. Diet
recommendations include limiting saturated and trans fat to less than 10%.
7. A patient has a decreased gag reflex, left-sided weakness, and drooling. Which action will the nurse take when feeding this patient?
a. Position in semi-Fowler’s.
b. Flex head with chin down.
c. Place food on the left side.
d. Offer fruit juice.
ANS: B
Have the patient flex the head slightly to a chin-down position to help prevent aspiration. If the patient has a unilateral weakness, teach him or her and the caregiver to place food on the stronger side of the mouth. Provide a 30-minute rest period before eating and position the patient in an upright, seated position in a chair or raise the head of the bed to 90 degrees. Thin liquids such as water
and fruit juice is difficult to control in the mouth and is more easily aspirated.
8. The patient who has been diagnosed with cardiovascular disease and placed on a low-fat diet asks the nurse, “How much fat
should I have? I guess the less fat, the better.” Which information will the nurse include in the teaching session?
a. Cholesterol intake needs to be less than 300 mg/day.
b. Fats have no significance in health and the incidence of disease.
c. All fats come from external sources, so this can be easily controlled.
d. Deficiencies occur when the fat intake falls below 10% of daily nutrition.
ANS: D
Deficiency occurs when the fat intake falls below 10% of daily nutrition. While keeping cholesterol below 300 mg is correct, it does not answer the patient’s question about fat. Various fatty acids have significance for health and the incidence of disease and are referred to in dietary guidelines. Linoleic acid and arachidonic acid
are important for metabolic processes but are manufactured by the body when linoleic acid is available from the diet.
9. The nurse is describing the ChooseMyPlate program to a patient. Which statement from the patient indicates successful learning?
a. “I can use this to make healthy lifestyle food choices.”
b. “I can use this to count specific calories of food.”
c. “I can use this for my baby girl.”
d. “I can use this when I am sick.”
ANS: A
ChooseMyPlate serves as a basic guide for making food choices for a healthy lifestyle. The U.S. Department of Agriculture developed the ChooseMyPlate program to replace the MyFoodPyramid program. It helps balance calories but does not provide specific calories of food. These guidelines are for Americans over the age of 2 years. These guidelines are provided for
health, not sickness.
10. The nurse is teaching a health class about the ChooseMyPlate program. Which guidelines will the nurse include in the teaching
session?
a. Balancing sodium and potassium
b. Decreasing water consumption
c. Increasing portion sized. Balancing calories
ANS: D
The ChooseMyPlate program includes guidelines for balancing calories, decreasing portion size; increasing healthy foods; increasing water consumption; and decreasing fats, sodium, and sugars. It does not balance sodium and potassium.
11. The nurse is providing nutrition education to a Korean patient using the five food groups. In doing so, what should be the focus of the teaching?
a. Discouraging the patient’s ethnic food choices
b. Changing the patient’s diet to a more conventional American diet
c. Including racial and ethnic practices with food preferences of the patient
d. Comparing the patient’s ethnic preferences with American dietary choices
ANS: C
As a nurse, consider patients’ food preferences from different racial and ethnic groups, vegetarians, and others when planning diets. Initiation of a balanced diet is more important than conversion to what may be considered an American diet. Ethnic food choices may be just as nutritious as American choices. Foods should be chosen for their nutritive value and should not be compared with the American diet.
12. A nurse is teaching a nutrition class about the different daily values. When teaching about the referenced daily intakes (RDIs),
which information should the nurse include?
a. Have values for protein, vitamins, and minerals.
b. Are based on percentages of fat, cholesterol, and fiber.
c. Have replaced recommended daily allowances (RDAs).
d. Are used to develop diets for chronic illnesses requiring 1800 cal/day.
ANS: A
The RDIs are the first set comprising protein, vitamins, and minerals based on the RDA. The daily reference values (DRVs) make up the second set and consist of nutrients such as total fat, saturated fat, cholesterol, carbohydrates, fiber, sodium, and potassium. Combined, both sets make up the daily values used on food labels. Daily values did not replace RDAs but provided a separate,
more understandable format for the public. Daily values are based on percentages of a diet consisting of 2000 kcal/day for adults and children 4 years or older.
13. The nurse is planning care for a group of stable patients. Which task will the nurse assign to the nursing assistive personnel?
a. Measuring the capillary blood glucose level
b. Measuring nasoenteric tube for insertion
c. Measuring pH in gastrointestinal aspirated. Measuring the patient’s risk for aspiration
ANS: A
The skill of measuring blood glucose level after skin puncture (capillary puncture) can be delegated to nursing assistive personnel when the patient’s condition is stable. The other skills cannot be delegated. A nurse must measure a nasoenteric tube for insertion, pH in gastrointestinal aspirate, and patient’s risk for aspiration.
14. In teaching mothers-to-be about infant nutrition, which instruction should the nurse provide?
a. Supplement breast milk with corn syrup.
b. Give cow’s milk during the first year of life.
c. Add honey to infant formulas for increased energy.
d. Provide breast milk or formula for the first 4 to 6 months.
ANS: D
Breast milk or formula provides sufficient nutrition for the first 4 to 6 months of life. Infants should not have regular cow’s milk during the first year of life. It is too concentrated for an infant’s kidneys to manage, increases the risk of milk product allergies, and is a poor source of iron and vitamins C and E. Furthermore, children under 1 year of age should never ingest honey and corn syrup products because they are potential sources of the botulism toxin, which increases the risk of infant death.
15. When planning care for an adolescent who plays sports, which modification should the nurse include in the care plan?
a. Increasing carbohydrates to 55% to 60% of total intake
b. Providing vitamin and mineral supplements
c. Decreasing protein intake to 0.75 g/kg/day
d. Limiting water before and after exercise
ANS: A
Sports and regular moderate to intense exercise necessitate a dietary modification to meet increased energy needs for adolescents. Both simple and complex, Carbohydrates are the main source of energy, providing 55% to 60% of total daily kilocalories. Protein needs to increase to 1 to 1.5 g/kg/day. Fat needs do not increase. Adequate hydration is very important. Adolescents need to ingest water before and after exercise to prevent dehydration, especially in hot, humid environments. Vitamin and mineral supplements
are not required, but intake of iron-rich foods is required to prevent anemia.
16. In providing prenatal care to a pregnant patient, what does the nurse teach the expectant mother?
a. Calcium intake is especially important in the first trimester.
b. Protein intake needs to decrease to preserve kidney function.
c. Folic acid is needed to help prevent birth defects and anemia.
d. Extra vitamins and minerals should be taken as much as possible.
ANS: C
Folic acid intake is particularly important for DNA synthesis and the growth of red blood cells. Inadequate intake may lead to fetal neural tube defects, anencephaly, or maternal megaloblastic anemia. Protein intake throughout pregnancy needs to increase to 60 g daily. Calcium intake is especially critical in the third trimester when fetal bones mineralize. Prenatal care usually includes vitamin and mineral supplementation to ensure daily intakes; however, pregnant women should not take additional supplements beyond
prescribed amounts.
17. The patient is an 80-year-old male who is visiting the clinic today for a routine physical examination. The patient’s skin turgor is fair, but the patient reports fatigue and weakness. The skin is warm and dry, pulse rate is 116 beats/min, and urinary sodium level is slightly elevated. Which instruction should the nurse provide?
a. Drink more water to prevent further dehydration.
b. Drink more calorie-dense fluids to increase caloric intake.
c. Drink more milk and dairy products to decrease the risk of osteoporosis.
d. Drink more grapefruit juice to enhance vitamin C intake and medication
absorption.
ANS: A
Thirst sensation diminishes, leading to inadequate fluid intake or dehydration; the patient should be encouraged to drink more water/fluids. Symptoms of dehydration in older adults include confusion, weakness, hot, dry skin, furrowed tongue, and high urinary sodium. Milk continues to be an important food for older women and men, who need adequate calcium to protect against
osteoporosis; the patient’s problem is dehydration, not osteoporosis. Caution older adults to avoid grapefruit and grapefruit juice because these will decrease absorption of many drugs. The patient needs fluids, not calories; drinking calorie-dense fluids is unnecessary.
18. The nurse is assessing a patient for nutritional status. Which action will the nurse take?
a. Forego the assessment in the presence of chronic disease.
b. Use the Mini Nutritional Assessment for pediatric patients.
c. Choose a single objective tool that fits the patient’s condition.
d. Combine multiple objective measures with subjective measures.
ANS: D
Combine multiple objective measures with subjective measures related to nutrition to adequately screen for nutritional problems. Using a single objective measure is ineffective in predicting the risk of nutritional problems. Chronic disease and increased metabolic requirements are risk factors for the development of nutritional problems; these patients may be in critical need of this assessment. The Mini Nutritional Assessment is used for screening older adults in-home care programs, nursing homes, and hospitals.
19. The patient has a calculated body mass index (BMI) of 34. How will the nurse classify this finding?
a. Normal weight
b. Underweight
c. Overweight
d. Obese
ANS: D
BMI greater than 30 is defined as obesity. BMI between 25 and 30 is classified as overweight. BMI from 18.5 to 24.9 is normal. BMI under 18.5 is underweight.
DIF: Understand (comprehension) OBJ: Discuss the major methods of nutritional assessment.
20. Which patient diagnosis increases the risk for developing neurogenic dysphagia?
a. Benign peptic stricture
b. Muscular dystrophy
c. Myasthenia gravis
d. Stroke
ANS: D
Stroke is the only cause of dysphagia in this list that is considered neurogenic. Myasthenia gravis and muscular dystrophy are considered myogenic in origin, whereas benign peptic stricture is considered obstructive.
21. The patient has been diagnosed with Helicobacter pylori. The nurse should encourage which action initially?
a. Avoidance of wheat and oats.
b. Milkshakes as a nutritious snack.
c. Completion of antibiotic therapy.
d. Nonsteroidal antiinflammatory drugs.
ANS: C
Helicobacter pylori, a bacterium that causes up to 85% of peptic ulcers, is confirmed by laboratory tests or a biopsy during endoscopy. Antibiotics treat and control bacterial infection. Avoidance of wheat and oats are required for patients with celiac disease who must follow a gluten-free diet. Encourage patients to avoid foods that increase stomach acidity and pain, such as
caffeine, decaffeinated coffee, frequent milk intake, citric acid juices, and certain seasonings (hot chili peppers, chili powder, black pepper). Discourage smoking, alcohol, aspirin, and nonsteroidal anti-inflammatory drugs (NSAIDs).
22. Which assessment finding is consistent with the diagnosis of malnutrition?
a. Moist lips
b. Pink conjunctivae
c. Spoon-shaped nails
d. Not easily plucked hair
ANS: C
Spoon-shaped nails, koilonychia, are an indication of poor nutrition. All the others are normal findings. Lips should be moist, conjunctivae should be pink, and hair should not be easily plucked.
23. A nurse is preparing to administer an enteral feeding. In which order will the nurse implement the steps, starting with the first one?
1. Elevate the head of the bed to at least 30 degrees.
2. Check for gastric residual volume.
3. Flush tubing with 30 mL of water.
4. Verify tube placement.
5. Initiate feeding.
a. 4, 2, 1, 5, 3
b. 2, 4, 1, 3, 5
c. 1, 4, 2, 3, 5
d. 2, 1, 4, 5, 3
ANS: C
The steps for an enteral feeding are as follows: place the patient in high-Fowler’s position or elevate the head of the bed to at least 30 (preferably 45) degrees, verify tube placement, check for gastric residual volume, flush tubing with 30 mL of water, and initiate feeding.
24. The patient is admitted with facial trauma, including a broken nose, and has a history of esophageal reflux and of aspiration pneumonia. With which tube will the nurse most likely administer the feeding?
a. Nasogastric tube
b. Jejunostomy tube
c. Nasointestinal tube
d. Percutaneous endoscopic gastrostomy (PEG) tube
ANS: B
Patients with gastroparesis or esophageal reflux or with a history of aspiration pneumonia may require placement of tubes beyond the stomach into the intestine. The jejunostomy tube is the only tube in the list that is beyond the stomach and is not contraindicated by facial trauma. The nasogastric tube and the PEG tube are placed in the stomach, and placement could lead to aspiration. The naso-intestinal tube and the nasogastric tube may be contraindicated by facial trauma and a broken nose.
25. The nurse is preparing to insert a nasogastric tube. To determine the length of the tube needed to be inserted, how should the nurse measure the tube?
a. From the tip of the nose to the earlobe
b. From the tip of the earlobe to the xiphoid process
c. From the tip of the earlobe to the nose to the xiphoid process
d. From the tip of the nose to the earlobe to the xiphoid process
ANS: D
Measure distance from the tip of the nose to the earlobe to the xiphoid process of the sternum. This approximates the distance from the nose to the stomach in 98% of patients. For duodenal or jejunal placement, an additional 20 to 30 cm is required.
26. Before giving the patient an intermittent gastric tube feeding, what should the nurse do?
a. Make sure that the tube is secured to the gown with a safety pin.
b. Inject air into the stomach via the tube and auscultate.
c. Have the tube feeding at room temperature.
d. Check to make sure pH is at least 5.
ANS: C
Be sure that the formula is at room temperature. Cold formula causes gastric cramping and discomfort because the mouth and the esophagus do not warm the liquid. Do not use safety pins. Safety pins can become unfastened and may cause harm to the patient. Auscultation is no longer considered a reliable method for verification of tube placement because a tube inadvertently placed in the lungs, pharynx, or esophagus transmits sound similar to that of air entering the stomach. The gastric fluid of patient who has fasted for
at least 4 hours usually have a pH of 1 to 4, especially when the patient is not receiving gastric-acid inhibitor.
27. A small-bore feeding tube is placed. Which technique will the nurse use to best verify tube placement?
a. X-ray
b. pH testing
c. Auscultation
d. Aspiration of contents
ANS: A
At present, the most reliable method for verification of placement of small-bore feeding tubes is x-ray examination. Aspiration of contents and pH testing are not infallible. The nurse would need a more precise indicator to help differentiate the source of tube feeding aspirate. Auscultation is no longer considered a reliable method for verification of tube placement because a tube inadvertently placed in the lungs, pharynx, or esophagus transmits sound similar to that of air entering the stomach.
28. The nurse is concerned about pulmonary aspiration when providing care to the patient with an intermittent tube feeding. Which action is the priority?
a. Observe the color of gastric contents.
b. Verify tube placement before feeding.
c. Add blue food coloring to the enteral formula.
d. Run the formula over 12 hours to decrease overload.
ANS: B
A major cause of pulmonary aspiration is a regurgitation of formula. The nurse needs to first verify tube placement and elevate the head of the bed 30 to 45 degrees during feedings and for 2 hours afterward. While observing the color of gastric contents is a component, it is not the priority component; pH is the primary component. The addition of blue food coloring to the enteral formula to assist with the detection of aspirate is no longer used. Do not hang formula longer than 4 to 8 hours. The formula becomes a medium for bacterial growth after that length of time.
29. The patient is to receive multiple medications via the nasogastric tube. The nurse is concerned that the tube may become clogged. Which action is best for the nurse to take?
a. Instill nonliquid medications without diluting.
b. Irrigate the tube with 60 mL of water after all medications are given.
c. Mix all medications together to decrease the number of administrations.
d. Check with the pharmacy for availability of the liquid forms of medications.
ANS: D
Use liquid medications when available to prevent tube occlusion. Irrigate with 30 mL of water before and after each medication per tube. Completely dissolve crushed medications in liquid if liquid medication is not available. Read pharmacological information on the compatibility of drugs and formula before mixing medications.
30. The patient has just started on enteral feedings and is now reporting abdominal cramping. Which action will the nurse take next?
a. Slow the rate of tube feeding.
b. Instill cold formula to “numb” the stomach.
c. Change the tube feeding to a high-fat formula.
d. Consult with the health care provider about prokinetic medication.
ANS: A
One possible cause of abdominal cramping is a rapid increase in rate or volume. Lowering the rate of delivery may increase tolerance. Another possible cause of abdominal cramping is the use of cold formula. The nurse should warm the formula to room temperature. High-fat formulas are also a cause of abdominal cramping. Consult with the health care provider regarding prokinetic medication for increasing gastric motility for delayed gastric emptying.
31. The patient has just been started on enteral feeding and has developed diarrhea after being on the feeding for 2 hours. What does the nurse suspect is the most likely cause of diarrhea?
a. Antibiotic therapy
b. Clostridium difficile
c. Formula intolerance
d. Bacterial contamination
ANS: C
Hyperosmolar formulas can cause diarrhea or formula intolerance. If that is the case, the solution is to lower the rate, dilute the formula, or change to an isotonic formula. Antibiotics destroy normal intestinal flora and disturb the internal ecology, allowing for C. difficile toxin buildup. However, this takes time (more than 2 hours), and no indication suggests that this patient is on antibiotics. Bacterial contamination of the feeding usually occurs when feedings are left hanging for longer than 8 hours.
32. A patient develops a foodborne disease from Escherichia coli. When taking a health history, which food item will the nurse most likely find the patient ingested?
a. Improperly home-canned food
b. Undercooked ground beef
c. Soft cheese
d. Custard
ANS: B
Undercooked ground beef is the usual food source for E. coli. Botulism is associated with improperly home-canned foods. Soft cheese is the usual food source for listeriosis. Custards are associated with salmonellosis and Staphylococcus.
33. The nurse is caring for a patient receiving total parenteral nutrition (TPN). Which action will the nurse take?
a. Run lipids for no longer than 24 hours.
b. Take down a running bag of TPN after 36 hours.
c. Clean injection port with alcohol 5 seconds before and after use.
d. Wear a sterile mask when changing the central venous catheter dressing.
ANS: D
During central venous catheter dressing changes, always use a sterile mask and gloves, and assess insertion sites for signs and symptoms of infection. To avoid infection, change the TPN infusion tubing every 24 hours, and do not hang a single container of PN for longer than 24 hours or lipids longer than 12 hours.
34. The patient is having at least 75% of nutritional needs met by enteral feeding, so the health care provider has ordered the parenteral nutrition (PN) to be discontinued. However, the nurse notices that the PN infusion has fallen behind. What should the nurse do?
a. Increase the rate to get the volume caught up before discontinuing.
b. Stop the infusion as ordered.
c. Taper infusion gradually.
d. Hang 5% dextrose.
ANS: C
Sudden discontinuation of PN can cause hypoglycemia. PN must be tapered off. Usually, 10% dextrose is infused when the PN solution is suddenly discontinued. Too rapid administration of hypertonic dextrose (PN) can result in osmotic diuresis and dehydration. If an infusion falls behind schedule, the nurse should not increase the rate in an attempt to catch up.
35. The patient is on parenteral nutrition, is lethargic while reporting thirst and headache, and has had increased urination. Which problem does the nurse prepare to address?
a. Hyperglycemia
b. Hypoglycemia
c. Hypercapnia
d. Hypocapnia
ANS: A
Signs and symptoms of hyperglycemia are thirst, headache, lethargy, and increased urination. Hypocapnia is not associated with parenteral nutrition. Hypercapnia increases oxygen consumption and increases CO2 levels. Ventilator-dependent patients are at the greatest risk for this. Hypoglycemia is characterized by diaphoresis, shakiness, confusion, and loss of consciousness.
36. In providing diabetic teaching for a patient with type 1 diabetes mellitus, which instructions will the nurse provide to the patient?
a. Insulin is the only consideration that must be taken into account.
b. Saturated fat should be limited to less than 7% of total calories.
c. Nonnutritive sweeteners can be used without restriction.
d. Cholesterol intake should be greater than 200 mg/day.
ANS: B
The diabetic patient should limit saturated fat to less than 7% of total calories and cholesterol intake to less than 200 mg/day. Type 1 diabetes requires both insulin and dietary restrictions for optimal control. Nonnutritive sweeteners can be eaten as long as the recommended daily intake levels are followed.
37. The patient diagnosed with cardiovascular disease is receiving dietary instructions from the nurse. Which information from the patient indicates teaching is successful?
a. Maintain a prescribed carbohydrate intake.
b. Eat fish at least 5 times/week.
c. Limit cholesterol to less than 300 mg/daily.
d. Avoid high-fiber foods.
ANS: C
American Heart Association guidelines recommend limiting cholesterol to less than 300 mg/day. Diet therapy includes eating fish at least 2 times per week and eating whole grain high-fiber foods. Maintaining a prescribed carbohydrate intake is necessary for diabetes mellitus.
38. The nurse is providing home care for a patient diagnosed with acquired immunodeficiency syndrome (AIDS). Which dietary intervention will the nurse add to the care plan?
a. Provide small, frequent nutrient-dense meals for maximizing kilocalories.
b. Prepare hot meals because they are more easily tolerated by the patient.
c. Avoid salty foods and limit liquids to preserve electrolytes.
d. Encourage intake of fatty foods to increase caloric intake.
ANS: A
Small, frequent, nutrient-dense meals that limit fatty foods and overly sweet foods are easier to tolerate. Restorative care of malnutrition resulting from AIDS focuses on maximizing kilocalories and nutrients. Patients benefit from eating cold foods and drier or saltier foods with fluid in between.
39. A patient is on a full liquid diet. Which food item choice by the patient will cause the nurse to intervene?
a. Custard
b. Frozen yogurt
c. Pureed vegetable
d. Mashed potatoes and gravy
ANS: D
Mashed potatoes and gravy are on dysphagia, mechanical soft, soft and regular diet but are not components of a full liquid diet. The nurse will need to provide teaching on what is allowed on a diet. Custard, frozen yogurt, and pureed vegetables are all on a full liquid diet.
40. A nurse is caring for a group of patients. Which patient will the nurse see first?
a. Patient receiving total parenteral nutrition of 2-in-1 for 50 hours
b. Patient receiving total parenteral nutrition infusing with the same tubing for 26 hours
c. Patient receiving continuous enteral feeding with same feeding bag for 12 hours
d. Patient receiving continuous enteral feeding with the same tubing for 24 hours
ANS: B
The nurse should see the patient with total parenteral nutrition that has the same tubing for 26 hours. To prevent infection, change the TPN infusion tubing every 24 hours. Change the administration system every 72 hours when infusing a 2-in-1 solution and every 24 hours for a 3-in-1 solution. Change bag and use a new administration set every 24 hours for continuous enteral feeding. While the patient with the continuous enteral feeding has the same tubing for 24 hours, it has not extended the time as the total parenteral nutrition has.
41. The nurse is preparing to check the gastric aspirate for pH. Which equipment will the nurse obtain?
a. 10-mL Luer-Lok syringe
b. Aseptic syringe
c. Sterile gloves
d. Double gloves
ANS: B
ENFit syringe is needed for testing gastric aspirate for pH; these syringes are better than a Luer-Lok syringe. Clean gloves are needed, not sterile or double.
MULTIPLE RESPONSE
1. A nurse is teaching a health class about the nutritional requirements throughout the life span. Which information should the nurse include in the teaching session? (Select all that apply.)
a. Infants triple weight at 1 year.
b. Toddlers become picky eaters.
c. School-age children need to avoid hot dogs and grapes.
d. Breastfeeding women need an additional 750 kcal/day.
e. Older adults have altered food flavor from a decrease in taste cells.
ANS: A, B, E
An infant usually doubles birth weight at 4 to 5 months and triples it at 1 year. Toddlers exhibit strong food preferences and become picky eaters. Older adults often experience a decrease in taste cells that alters food flavor and may decrease intake. Toddlers need to avoid hot dogs and grapes, not school-age children. The lactating woman needs 500 kcal/day above the usual
allowance because the production of milk increases energy requirements.
2. The patient is asking the nurse about the best way to stay healthy. The nurse explains to the patient which teaching points? (Select all that apply.)
a. Increase physical activity.
b. Keep total fat intake to 10% or less.
c. Maintain body weight in a healthy range.
d. Choose and prepare foods with a little salt.
e. Increase intake of meat and other high-protein foods.
ANS: A, C, D
Recommendations include maintaining body weight in a healthy range; increasing physical activity and decreasing sedentary activities; increasing intake of fruits, vegetables, whole grain products, and fat-free or low-fat milk; eating a moderate amount of lean meats, poultry, and eggs; keeping fat intake between 20% and 35% of total calories, with most fats coming from polyunsaturated or monounsaturated fatty acids (most meats contain saturated fatty acids); and choosing prepared foods with a little salt while at the same time eating potassium-rich foods.
3. When assessing patients with nutritional needs, which patients will require follow-up from the nurse? (Select all that apply.)
a. A patient with infection taking tetracycline with milk
b. A patient with irritable bowel syndrome increasing fiber
c. A patient with diverticulitis following a high-fiber diet daily
d. A patient with enteral feeding and 500 mL of gastric residual
e. A patient with dysphagia being referred to a speech-language pathologist
ANS: A, C, D
The nurse should follow up with the tetracycline, diverticulitis, and enteral feeding. Tetracycline has decreased drug absorption with milk and antacids and has decreased nutrient absorption of calcium from binding. Nutritional treatment for diverticulitis includes a moderate- or low-residue diet until the infection subsides. Afterward, prescribing a high-fiber diet for chronic diverticula problems ensues. A patient with a gastric residual volume of 500 mL needs to have the feeding withheld and reassessed for tolerance to feedings. All the rest are normal and expected and do not require follow-up. Patients manage irritable bowel syndrome by increasing fiber, reducing fat, avoiding large meals, and avoiding lactose or sorbitol-containing foods for susceptible individuals. Initiate consultation with a speech-language pathologist for swallowing exercises and techniques to improve
swallowing and reduce the risk of aspiration for a patient with dysphagia.
4. To honor the cultural values of patients from different ethnic/religious groups, which actions demonstrate culturally sensitive care by the nurse? (Select all that apply.)
a. Allows fasting on Yom Kippur for a Jewish patient.
b. Allows caffeine drinks for a Mormon patient.
c. Serves no ham products to a Muslim patient.
d. Serves kosher foods to a Christian patient.
e. Serves no meat or fish to a Hindu patient.
ANS: A, C, E
The Jewish religion fasts 24 hours on Yom Kippur and must adhere to kosher food preparation methods. Hinduism requires no meats or fish. Muslims do not eat pork. Mormons do not drink caffeinated or alcoholic drinks.