Chapter06:NutritionalTherapy
1. ApatientishavingcomplicationsfromabdominalsurgeryandremainsNPO.Becaus
b. Fluidandelectrolyteimbalancesan eenteraltube-
dsepsis feedingsarenotpossible,thedecisionistoinitiateparenteralfeedings.Whatarethemajor
complica- tionsforthistherapy
.Apatientisbeingventilatedandhasbeenstartedonenteralfeedingswithanasogas
d. -
Topreventaspirationofthefeedi mall-
ngs borefeedingtube.Whatistheprimaryreasonthenursemustfrequentlyassesstubep
lace- ment?
d. Subclavianvein
3.Thepatientistostartparenteralnutrition.Thenurseknowstopreparewhichsitefo
rcatheterinser- tion?
4.Apatienthasbeenadmittedtothecriticalcareunitafterastroke.Afterfailingaswallowstu
hepa-
c.Obtainachestradiogr tientisplacedonenteralfeedings.Followingplacementofanasogastrictubefortu
aph. befeed- ing,whatisthenextcriticalstep?
c. theintestinalmucosanormallyreceivesnutrientsfromthestomachinperistalticwaves
5.Apatientsfeedingtubehasbeensuccessfullyplacedinthesmallintestinewithcon
ousflow-
tubefeeding.Thenurseknowsthatthisapproachwaschosenbecause:
Elevatetheheadofthebed30degrees.
6.Apatientisbeingfedthroughanasogastrictubeplacedinhisstomach.Thenursewo
arryout-
whichinterventiontominimizeaspirationrisk?
d. tube feeding intolerance.
7.Apatientwhoisreceivingcontinuousenteralfeedingshasjustvomited250mLofmi
lkygreenflu-
id.Thisisaconcernbecausethismostlikelydemonstratesthatthepatienthas:
8. Apatientisreceivingenteralfeedingsandhasjustvomited250mLofmilkygreenliqu
henurse-
d. recheck the residual in holdsthetubefeeding,whichhadbeeninfusingat100mL/hr.Thenurseknowsthatthenex
2hours taction- shouldbe:
a. Abdominal distention
9.Inadditiontoresidualstomachvolume,whatotherevidencesuggestsfeedingint
ance?
a. Clostridium diflcile
10.Approximately5daysafterstartingtubefeedings,apatientdevelopsextremedia
rrhea.Astool- specimeniscollectedtocheckforwhichpossiblecause?
11.Apatientwithacutepancreatitisisstartedonparenteralnutrition.Thestudentnu
istedpossi-
b. Infuseantibioticsthroughtheintraven bleinterventionsforthispatient.Whichinterventionneedscorrectionbeforefinalizingt
ousline. heplanof- care?
c. Prealbumin
, 12.Inevaluatingapatientsnutrition,thenursewouldmonitorwhichbloodtestasthe
mostsensi- tiveindicatorofproteinsynthesisandcatabolism?
13.Apatientisreceivingenteraltubefeedingsandhasdevelopeddrug-
d. Phenytoin
nutrientinterac-
tions.Thenurserecognizeswhichdrugashavingthepotentialforcausingdrug-
nutrientreactions?
d. Without nutritional stimulation, mucosal villi atrophy. 14.Whichstatementistrueaboutnormalfunctionofthegastrointestinal(GI)tract?
c. potential for drug-nutrient interaction related to polypharmacy. 15.An important nutritional consideration in the elderly population is
d. weight loss, elevated glucose, and dehydration 16.Objectivedatadesignatingthatthenutritiongoalsarenotbeingmetinclude:
17.In trauma patients ,enteral nutrition via nasogastric tube feedings into the
a. 24hours
small bowel is best initiated within what time frame following the injury?
18.Apatientwithahistoryofemphysema,diabetes,andhyperlipidemiaisinthecritic
areuniton-
b. Fiber- aventilator.Thenutritionassessmentnotesthatthepatienthasaproteinandvitamindefi
addedformula ciencyan-
disunderweight.Whichformulafornutritionalassessmentismostappropriate?
d. Gut mucosa is preserved.
19.Selectthephysiologicalreasoningbehindenteraltherapyasthepreferredsource
altherapy
utrition-
, b. The patient with ileitis
20.Thenurseidentifieswhichpatientatgreatestriskformalabsorptionofprot
?
b. flushthetubeevery4hourswith20to30mLoftapwater. 21.Thebestnursingapproachtopreventfeedingtubeobstructionis:
c. 35kcal/kg/day
22.Patientsexperiencingseverephysiologicalstressincreasetheirnutritionalrequ
mentsto:
b. impairing immune function 23.Malnutritioncontributestoinfectionriskby
24.Apatient,whohasatubefeeding,requiresachestx-
d. stopsfeedings10to15minutesbeforeplacingflattoobtaintheradiograph.
raystudyforevaluationofacough.Tore-
ducetheriskofaspiration,thenurse:
a. Assessingfluidvolumestatusandpreventinginfectionareimportantnursingcon
siderations.b. Fingerstickglucoselevelsareassessedevery6hoursandprn.
1. Whichstatement(s)abouttotalparenteralnutritionis(are)true?(Selectalltha
d.
ply.)
Totalparenteralnutrition,withaddedlipids,providesadequatelevelsofprotein,
carbohy- drates,andfats.
b. Changethetubingevery24h 2. Whichintervention(s)is(are)criticalduringintravenouslipidadministration?(Selecta
ours. llthatap- ply).
d.
Monitortriglyceridelevels.
a. are most useful in heart failure and liver disease. 3.Calorie-densefeedings:(Selectallthatapply.)
b. elevatedbloodsugar.
c. infectionatthecathetersite.
d. volumeoverload.
a. Amountofparenteralinsulinisadjustedbasedontheprevious24-
hourlaboratoryvalues.
d. Respiratoryalkalosis
b. Insulinmaybeaddedtoaparenteralnutritionsolution.
c. Subcutaneousinsulinisusedonaslidingscaleduringparenteralnutrition.
A.Initiatetubefeeding. B.Insertfeedingtube. C.Flushtubetoverifypatency.
D.Obtainchestradi- ograph. E.Assessresiduals. ANS: B,D,C,A,E
d. Uncompensat a. Decrease in cardiac output
ed respiratory
acidosis;
hyperoxygenat
ed c. is done as indicated by patient assessment.
, 4. Risksoftotalparenteralnutritioninclude:(Selectallthatapply.)
5. Whichofthefollowingstatementsistrueaboutinsulinandparenteralnutrition?(Sele
ctallthatap- ply.)
Thecorrectorderofactionsforapatientstartingenteralnutritionwithafeedingt
ubeis:
1. Apatienthascoronaryarterybypassgraftsurgeryandistransportedtothesurgicalint
ensivecare-
unitatnoon.Heisplacedonmechanicalventilation.Interprethisinitialarterialb
loodgaslevels: pH7.31
PaCO248m
mHg
Bicarbonate22
mEq/L
PaO2115m
mHg
O2saturatio
n99%
2. Thephysicianordersthefollowingmechanicalventilationsettingsforapatient
-
whoweighs75kg.Thepatientsspontaneousrespiratoryrateis22breaths/min.Whatart
erialblood-
gasabnormalitymayoccurifthepatientcontinuestobetachypneicattheseventi
latorsettings? Settings:
Tidalvolume:600mL(8mLperkg
) FiO2:0.5
Respiratoryrate:14breaths/min
Modeassist/ control
3. Apatientsventilatorsettingsareadjustedtotreathypoxemia.Thefractionofinspir
edoxygenisin- creasedfrom.60to.70,andthepositiveend-
expiratorypressureisincreased-
from10to15cmH2O.Shortlyaftertheseadjustments,thenursenotesthatthepatient
sbloodpres-
suredropsfrom120/76mmHgto90/60mmHg.Whatisthemostlikelycauseofthi
sdecreasein- bloodpressure?
1. ApatientishavingcomplicationsfromabdominalsurgeryandremainsNPO.Becaus
b. Fluidandelectrolyteimbalancesan eenteraltube-
dsepsis feedingsarenotpossible,thedecisionistoinitiateparenteralfeedings.Whatarethemajor
complica- tionsforthistherapy
.Apatientisbeingventilatedandhasbeenstartedonenteralfeedingswithanasogas
d. -
Topreventaspirationofthefeedi mall-
ngs borefeedingtube.Whatistheprimaryreasonthenursemustfrequentlyassesstubep
lace- ment?
d. Subclavianvein
3.Thepatientistostartparenteralnutrition.Thenurseknowstopreparewhichsitefo
rcatheterinser- tion?
4.Apatienthasbeenadmittedtothecriticalcareunitafterastroke.Afterfailingaswallowstu
hepa-
c.Obtainachestradiogr tientisplacedonenteralfeedings.Followingplacementofanasogastrictubefortu
aph. befeed- ing,whatisthenextcriticalstep?
c. theintestinalmucosanormallyreceivesnutrientsfromthestomachinperistalticwaves
5.Apatientsfeedingtubehasbeensuccessfullyplacedinthesmallintestinewithcon
ousflow-
tubefeeding.Thenurseknowsthatthisapproachwaschosenbecause:
Elevatetheheadofthebed30degrees.
6.Apatientisbeingfedthroughanasogastrictubeplacedinhisstomach.Thenursewo
arryout-
whichinterventiontominimizeaspirationrisk?
d. tube feeding intolerance.
7.Apatientwhoisreceivingcontinuousenteralfeedingshasjustvomited250mLofmi
lkygreenflu-
id.Thisisaconcernbecausethismostlikelydemonstratesthatthepatienthas:
8. Apatientisreceivingenteralfeedingsandhasjustvomited250mLofmilkygreenliqu
henurse-
d. recheck the residual in holdsthetubefeeding,whichhadbeeninfusingat100mL/hr.Thenurseknowsthatthenex
2hours taction- shouldbe:
a. Abdominal distention
9.Inadditiontoresidualstomachvolume,whatotherevidencesuggestsfeedingint
ance?
a. Clostridium diflcile
10.Approximately5daysafterstartingtubefeedings,apatientdevelopsextremedia
rrhea.Astool- specimeniscollectedtocheckforwhichpossiblecause?
11.Apatientwithacutepancreatitisisstartedonparenteralnutrition.Thestudentnu
istedpossi-
b. Infuseantibioticsthroughtheintraven bleinterventionsforthispatient.Whichinterventionneedscorrectionbeforefinalizingt
ousline. heplanof- care?
c. Prealbumin
, 12.Inevaluatingapatientsnutrition,thenursewouldmonitorwhichbloodtestasthe
mostsensi- tiveindicatorofproteinsynthesisandcatabolism?
13.Apatientisreceivingenteraltubefeedingsandhasdevelopeddrug-
d. Phenytoin
nutrientinterac-
tions.Thenurserecognizeswhichdrugashavingthepotentialforcausingdrug-
nutrientreactions?
d. Without nutritional stimulation, mucosal villi atrophy. 14.Whichstatementistrueaboutnormalfunctionofthegastrointestinal(GI)tract?
c. potential for drug-nutrient interaction related to polypharmacy. 15.An important nutritional consideration in the elderly population is
d. weight loss, elevated glucose, and dehydration 16.Objectivedatadesignatingthatthenutritiongoalsarenotbeingmetinclude:
17.In trauma patients ,enteral nutrition via nasogastric tube feedings into the
a. 24hours
small bowel is best initiated within what time frame following the injury?
18.Apatientwithahistoryofemphysema,diabetes,andhyperlipidemiaisinthecritic
areuniton-
b. Fiber- aventilator.Thenutritionassessmentnotesthatthepatienthasaproteinandvitamindefi
addedformula ciencyan-
disunderweight.Whichformulafornutritionalassessmentismostappropriate?
d. Gut mucosa is preserved.
19.Selectthephysiologicalreasoningbehindenteraltherapyasthepreferredsource
altherapy
utrition-
, b. The patient with ileitis
20.Thenurseidentifieswhichpatientatgreatestriskformalabsorptionofprot
?
b. flushthetubeevery4hourswith20to30mLoftapwater. 21.Thebestnursingapproachtopreventfeedingtubeobstructionis:
c. 35kcal/kg/day
22.Patientsexperiencingseverephysiologicalstressincreasetheirnutritionalrequ
mentsto:
b. impairing immune function 23.Malnutritioncontributestoinfectionriskby
24.Apatient,whohasatubefeeding,requiresachestx-
d. stopsfeedings10to15minutesbeforeplacingflattoobtaintheradiograph.
raystudyforevaluationofacough.Tore-
ducetheriskofaspiration,thenurse:
a. Assessingfluidvolumestatusandpreventinginfectionareimportantnursingcon
siderations.b. Fingerstickglucoselevelsareassessedevery6hoursandprn.
1. Whichstatement(s)abouttotalparenteralnutritionis(are)true?(Selectalltha
d.
ply.)
Totalparenteralnutrition,withaddedlipids,providesadequatelevelsofprotein,
carbohy- drates,andfats.
b. Changethetubingevery24h 2. Whichintervention(s)is(are)criticalduringintravenouslipidadministration?(Selecta
ours. llthatap- ply).
d.
Monitortriglyceridelevels.
a. are most useful in heart failure and liver disease. 3.Calorie-densefeedings:(Selectallthatapply.)
b. elevatedbloodsugar.
c. infectionatthecathetersite.
d. volumeoverload.
a. Amountofparenteralinsulinisadjustedbasedontheprevious24-
hourlaboratoryvalues.
d. Respiratoryalkalosis
b. Insulinmaybeaddedtoaparenteralnutritionsolution.
c. Subcutaneousinsulinisusedonaslidingscaleduringparenteralnutrition.
A.Initiatetubefeeding. B.Insertfeedingtube. C.Flushtubetoverifypatency.
D.Obtainchestradi- ograph. E.Assessresiduals. ANS: B,D,C,A,E
d. Uncompensat a. Decrease in cardiac output
ed respiratory
acidosis;
hyperoxygenat
ed c. is done as indicated by patient assessment.
, 4. Risksoftotalparenteralnutritioninclude:(Selectallthatapply.)
5. Whichofthefollowingstatementsistrueaboutinsulinandparenteralnutrition?(Sele
ctallthatap- ply.)
Thecorrectorderofactionsforapatientstartingenteralnutritionwithafeedingt
ubeis:
1. Apatienthascoronaryarterybypassgraftsurgeryandistransportedtothesurgicalint
ensivecare-
unitatnoon.Heisplacedonmechanicalventilation.Interprethisinitialarterialb
loodgaslevels: pH7.31
PaCO248m
mHg
Bicarbonate22
mEq/L
PaO2115m
mHg
O2saturatio
n99%
2. Thephysicianordersthefollowingmechanicalventilationsettingsforapatient
-
whoweighs75kg.Thepatientsspontaneousrespiratoryrateis22breaths/min.Whatart
erialblood-
gasabnormalitymayoccurifthepatientcontinuestobetachypneicattheseventi
latorsettings? Settings:
Tidalvolume:600mL(8mLperkg
) FiO2:0.5
Respiratoryrate:14breaths/min
Modeassist/ control
3. Apatientsventilatorsettingsareadjustedtotreathypoxemia.Thefractionofinspir
edoxygenisin- creasedfrom.60to.70,andthepositiveend-
expiratorypressureisincreased-
from10to15cmH2O.Shortlyaftertheseadjustments,thenursenotesthatthepatient
sbloodpres-
suredropsfrom120/76mmHgto90/60mmHg.Whatisthemostlikelycauseofthi
sdecreasein- bloodpressure?
