TEST BANK INTRODUCTION TO
CRITICAL CARE NURSING 7TH EDITION
Chapter06:NutritionalTherapy - ANSWERS-
1.ApatientishavingcomplicationsfromabdominalsurgeryandremainsNPO.Becauseenteral
tubefeedingsarenotpossible,thedecisionistoinitiateparenteralfeedings.Whatarethemajorc
omplicationsforthistherapy - ANSWERS-b. Fluidandelectrolyteimbalancesandsepsis
.Apatientisbeingventilatedandhasbeenstartedonenteralfeedingswithanasogastricsmall-
borefeedingtube.Whatistheprimaryreasonthenursemustfrequentlyassesstubeplacement
? - ANSWERS-d. Topreventaspirationofthefeedings
3.Thepatientistostartparenteralnutrition.Thenurseknowstopreparewhichsiteforcatheterins
ertion? - ANSWERS-d. Subclavianvein
4.Apatienthasbeenadmittedtothecriticalcareunitafterastroke.Afterfailingaswallowstudy,th
epatientisplacedonenteralfeedings.Followingplacementofanasogastrictubefortubefeedin
g,whatisthenextcriticalstep? - ANSWERS-c. Obtainachestradiograph.
5.Apatientsfeedingtubehasbeensuccessfullyplacedinthesmallintestinewithcontinuousflo
wtubefeeding.Thenurseknowsthatthisapproachwaschosenbecause: - ANSWERS-c.
theintestinalmucosanormallyreceivesnutrientsfromthestomachinperistalticwaves
6.Apatientisbeingfedthroughanasogastrictubeplacedinhisstomach.Thenursewouldcarryo
utwhichinterventiontominimizeaspirationrisk? - ANSWERS-
Elevatetheheadofthebed30degrees.
7.Apatientwhoisreceivingcontinuousenteralfeedingshasjustvomited250mLofmilkygreenfl
uid.Thisisaconcernbecausethismostlikelydemonstratesthatthepatienthas: - ANSWERS-
d. tube feeding intolerance.
8.Apatientisreceivingenteralfeedingsandhasjustvomited250mLofmilkygreenliquid.Thenur
seholdsthetubefeeding,whichhadbeeninfusingat100mL/
hr.Thenurseknowsthatthenextactionshouldbe: - ANSWERS-d. recheck the residual in
2hours
9.Inadditiontoresidualstomachvolume,whatotherevidencesuggestsfeedingintolerance? -
ANSWERS-a. Abdominal distention
10.Approximately5daysafterstartingtubefeedings,apatientdevelopsextremediarrhea.Asto
olspecimeniscollectedtocheckforwhichpossiblecause? - ANSWERS-a. Clostridium
difficile
11.Apatientwithacutepancreatitisisstartedonparenteralnutrition.Thestudentnurselistedpo
ssibleinterventionsforthispatient.Whichinterventionneedscorrectionbeforefinalizingthepla
nofcare? - ANSWERS-b. Infuseantibioticsthroughtheintravenousline.
12.Inevaluatingapatientsnutrition,thenursewouldmonitorwhichbloodtestasthemostsensiti
veindicatorofproteinsynthesisandcatabolism? - ANSWERS-c. Prealbumin
13.Apatientisreceivingenteraltubefeedingsandhasdevelopeddrug-
nutrientinteractions.Thenurserecognizeswhichdrugashavingthepotentialforcausingdrug-
nutrientreactions? - ANSWERS-d. Phenytoin
14.Whichstatementistrueaboutnormalfunctionofthegastrointestinal(GI)tract? -
ANSWERS-d. Without nutritional stimulation, mucosal villi atrophy.
,15.An important nutritional consideration in the elderly population is: - ANSWERS-c.
potential for drug-nutrient interaction related to polypharmacy.
16.Objectivedatadesignatingthatthenutritiongoalsarenotbeingmetinclude: - ANSWERS-
d. weight loss, elevated glucose, and dehydration
17.In trauma patients ,enteral nutrition via nasogastric tube feedings into the small
bowel is best initiated within what time frame following the injury? - ANSWERS-a.
24hours
18.Apatientwithahistoryofemphysema,diabetes,andhyperlipidemiaisinthecriticalcareunito
naventilator.Thenutritionassessmentnotesthatthepatienthasaproteinandvitamindeficienc
yandisunderweight.Whichformulafornutritionalassessmentismostappropriate? -
ANSWERS-b. Fiber-addedformula
19.Selectthephysiologicalreasoningbehindenteraltherapyasthepreferredsourceofnutrition
altherapy - ANSWERS-d. Gut mucosa is preserved.
20.Thenurseidentifieswhichpatientatgreatestriskformalabsorptionofprotein? -
ANSWERS-b. The patient with ileitis
21.Thebestnursingapproachtopreventfeedingtubeobstructionis: - ANSWERS-b.
flushthetubeevery4hourswith20to30mLoftapwater.
22.Patientsexperiencingseverephysiologicalstressincreasetheirnutritionalrequirementsto
: - ANSWERS-c. 35kcal/kg/day
23.Malnutritioncontributestoinfectionriskby - ANSWERS-b. impairing immune function
24.Apatient,whohasatubefeeding,requiresachestx-
raystudyforevaluationofacough.Toreducetheriskofaspiration,thenurse: - ANSWERS-d.
stopsfeedings10to15minutesbeforeplacingflattoobtaintheradiograph.
1.Whichstatement(s)abouttotalparenteralnutritionis(are)true?(Selectallthatapply.) -
ANSWERS-a.
Assessingfluidvolumestatusandpreventinginfectionareimportantnursingconsiderations.b.
Fingerstickglucoselevelsareassessedevery6hoursandprn.
d.
Totalparenteralnutrition,withaddedlipids,providesadequatelevelsofprotein,carbohydrates,
andfats.
2.Whichintervention(s)is(are)criticalduringintravenouslipidadministration?
(Selectallthatapply). - ANSWERS-b. Changethetubingevery24hours.
d. Monitortriglyceridelevels.
3.Calorie-densefeedings:(Selectallthatapply.) - ANSWERS-a. are most useful in heart
failure and liver disease.
4.Risksoftotalparenteralnutritioninclude:(Selectallthatapply.) - ANSWERS-b.
elevatedbloodsugar.
c. infectionatthecathetersite.
d. volumeoverload.
5.Whichofthefollowingstatementsistrueaboutinsulinandparenteralnutrition?
(Selectallthatapply.) - ANSWERS-a.
Amountofparenteralinsulinisadjustedbasedontheprevious24-hourlaboratoryvalues.
b. Insulinmaybeaddedtoaparenteralnutritionsolution.
c. Subcutaneousinsulinisusedonaslidingscaleduringparenteralnutrition.
, Thecorrectorderofactionsforapatientstartingenteralnutritionwithafeedingtubeis:__ -
ANSWERS-A.Initiatetubefeeding. B.Insertfeedingtube. C.Flushtubetoverifypatency.
D.Obtainchestradiograph. E.Assessresiduals. ANS: B,D,C,A,E
1.Apatienthascoronaryarterybypassgraftsurgeryandistransportedtothesurgicalintensivec
areunitatnoon.Heisplacedonmechanicalventilation.Interprethisinitialarterialbloodgaslevel
s:
pH7.31
PaCO248mmHg
Bicarbonate22mEq/L
PaO2115mmHg
O2saturation99% - ANSWERS-d. Uncompensated
respiratory
acidosis;
hyperoxygenated
2.Thephysicianordersthefollowingmechanicalventilationsettingsforapatientwhoweighs75
kg.Thepatientsspontaneousrespiratoryrateis22breaths/
min.Whatarterialbloodgasabnormalitymayoccurifthepatientcontinuestobetachypneicatthe
seventilatorsettings?
Settings:
Tidalvolume:600mL(8mLperkg)
FiO2:0.5
Respiratoryrate:14breaths/min
Modeassist/ control - ANSWERS-d. Respiratoryalkalosis
3.Apatientsventilatorsettingsareadjustedtotreathypoxemia.Thefractionofinspiredoxygenis
increasedfrom.60to.70,andthepositiveend-
expiratorypressureisincreasedfrom10to15cmH2O.Shortlyaftertheseadjustments,thenurs
enotesthatthepatientsbloodpressuredropsfrom120/76mmHgto90/60mmHg.Whatisthemo
stlikelycauseofthisdecreaseinbloodpressure? - ANSWERS-a. Decrease in cardiac
output
4.Thenurseiscaringforapatientwithanendotrachealtube.Thenurseunderstandsthatendotra
chealsuctioningisneededtofacilitateremovalofsecretionsandthattheprocedure: -
ANSWERS-c. is done as indicated by patient assessment.
5.A65-year-oldpatientisadmittedtotheprogressivecareunitwithadiagnosisofcommunity-
acquiredpneumonia.Thepatienthasahistoryofchronicobstructivepulmonarydiseaseanddia
betes.Asetofarterialbloodgasesobtainedonadmissionwithoutsupplementaloxygenshowsp
H7.35;PaCO255mmHg;bicarbonate30mEq/L;PaO265mmHg.Thesebloodgasesreflect: -
ANSWERS-hypoxemia and compensated respiratory acidosis
6.Apatientsstatusworsensandneedsmechanicalventilation.Thepulmonologistwantsthepat
ienttoreceive10breaths/
minfromtheventilatorbutwantstoencouragethepatienttobreathespontaneouslyinbetweent
hemechanicalbreathsathisowntidalvolume.Thismodeofventilationiscalled: - ANSWERS-
c. intermittent mandatory ventilation
7.Apatientsendotrachealtubeisnotsecuredtightly.Therespiratorycarepractitionerassiststh
enurseintapingthetube.Afterthetubeisretaped,thenurseauscultatesthepatientslungsandn
otesthatthebreathsoundsovertheleftlungfieldsareabsent.Thenursesuspectsthat: -
ANSWERS-a. the endotracheal tube is in the right main stem bronchus.
CRITICAL CARE NURSING 7TH EDITION
Chapter06:NutritionalTherapy - ANSWERS-
1.ApatientishavingcomplicationsfromabdominalsurgeryandremainsNPO.Becauseenteral
tubefeedingsarenotpossible,thedecisionistoinitiateparenteralfeedings.Whatarethemajorc
omplicationsforthistherapy - ANSWERS-b. Fluidandelectrolyteimbalancesandsepsis
.Apatientisbeingventilatedandhasbeenstartedonenteralfeedingswithanasogastricsmall-
borefeedingtube.Whatistheprimaryreasonthenursemustfrequentlyassesstubeplacement
? - ANSWERS-d. Topreventaspirationofthefeedings
3.Thepatientistostartparenteralnutrition.Thenurseknowstopreparewhichsiteforcatheterins
ertion? - ANSWERS-d. Subclavianvein
4.Apatienthasbeenadmittedtothecriticalcareunitafterastroke.Afterfailingaswallowstudy,th
epatientisplacedonenteralfeedings.Followingplacementofanasogastrictubefortubefeedin
g,whatisthenextcriticalstep? - ANSWERS-c. Obtainachestradiograph.
5.Apatientsfeedingtubehasbeensuccessfullyplacedinthesmallintestinewithcontinuousflo
wtubefeeding.Thenurseknowsthatthisapproachwaschosenbecause: - ANSWERS-c.
theintestinalmucosanormallyreceivesnutrientsfromthestomachinperistalticwaves
6.Apatientisbeingfedthroughanasogastrictubeplacedinhisstomach.Thenursewouldcarryo
utwhichinterventiontominimizeaspirationrisk? - ANSWERS-
Elevatetheheadofthebed30degrees.
7.Apatientwhoisreceivingcontinuousenteralfeedingshasjustvomited250mLofmilkygreenfl
uid.Thisisaconcernbecausethismostlikelydemonstratesthatthepatienthas: - ANSWERS-
d. tube feeding intolerance.
8.Apatientisreceivingenteralfeedingsandhasjustvomited250mLofmilkygreenliquid.Thenur
seholdsthetubefeeding,whichhadbeeninfusingat100mL/
hr.Thenurseknowsthatthenextactionshouldbe: - ANSWERS-d. recheck the residual in
2hours
9.Inadditiontoresidualstomachvolume,whatotherevidencesuggestsfeedingintolerance? -
ANSWERS-a. Abdominal distention
10.Approximately5daysafterstartingtubefeedings,apatientdevelopsextremediarrhea.Asto
olspecimeniscollectedtocheckforwhichpossiblecause? - ANSWERS-a. Clostridium
difficile
11.Apatientwithacutepancreatitisisstartedonparenteralnutrition.Thestudentnurselistedpo
ssibleinterventionsforthispatient.Whichinterventionneedscorrectionbeforefinalizingthepla
nofcare? - ANSWERS-b. Infuseantibioticsthroughtheintravenousline.
12.Inevaluatingapatientsnutrition,thenursewouldmonitorwhichbloodtestasthemostsensiti
veindicatorofproteinsynthesisandcatabolism? - ANSWERS-c. Prealbumin
13.Apatientisreceivingenteraltubefeedingsandhasdevelopeddrug-
nutrientinteractions.Thenurserecognizeswhichdrugashavingthepotentialforcausingdrug-
nutrientreactions? - ANSWERS-d. Phenytoin
14.Whichstatementistrueaboutnormalfunctionofthegastrointestinal(GI)tract? -
ANSWERS-d. Without nutritional stimulation, mucosal villi atrophy.
,15.An important nutritional consideration in the elderly population is: - ANSWERS-c.
potential for drug-nutrient interaction related to polypharmacy.
16.Objectivedatadesignatingthatthenutritiongoalsarenotbeingmetinclude: - ANSWERS-
d. weight loss, elevated glucose, and dehydration
17.In trauma patients ,enteral nutrition via nasogastric tube feedings into the small
bowel is best initiated within what time frame following the injury? - ANSWERS-a.
24hours
18.Apatientwithahistoryofemphysema,diabetes,andhyperlipidemiaisinthecriticalcareunito
naventilator.Thenutritionassessmentnotesthatthepatienthasaproteinandvitamindeficienc
yandisunderweight.Whichformulafornutritionalassessmentismostappropriate? -
ANSWERS-b. Fiber-addedformula
19.Selectthephysiologicalreasoningbehindenteraltherapyasthepreferredsourceofnutrition
altherapy - ANSWERS-d. Gut mucosa is preserved.
20.Thenurseidentifieswhichpatientatgreatestriskformalabsorptionofprotein? -
ANSWERS-b. The patient with ileitis
21.Thebestnursingapproachtopreventfeedingtubeobstructionis: - ANSWERS-b.
flushthetubeevery4hourswith20to30mLoftapwater.
22.Patientsexperiencingseverephysiologicalstressincreasetheirnutritionalrequirementsto
: - ANSWERS-c. 35kcal/kg/day
23.Malnutritioncontributestoinfectionriskby - ANSWERS-b. impairing immune function
24.Apatient,whohasatubefeeding,requiresachestx-
raystudyforevaluationofacough.Toreducetheriskofaspiration,thenurse: - ANSWERS-d.
stopsfeedings10to15minutesbeforeplacingflattoobtaintheradiograph.
1.Whichstatement(s)abouttotalparenteralnutritionis(are)true?(Selectallthatapply.) -
ANSWERS-a.
Assessingfluidvolumestatusandpreventinginfectionareimportantnursingconsiderations.b.
Fingerstickglucoselevelsareassessedevery6hoursandprn.
d.
Totalparenteralnutrition,withaddedlipids,providesadequatelevelsofprotein,carbohydrates,
andfats.
2.Whichintervention(s)is(are)criticalduringintravenouslipidadministration?
(Selectallthatapply). - ANSWERS-b. Changethetubingevery24hours.
d. Monitortriglyceridelevels.
3.Calorie-densefeedings:(Selectallthatapply.) - ANSWERS-a. are most useful in heart
failure and liver disease.
4.Risksoftotalparenteralnutritioninclude:(Selectallthatapply.) - ANSWERS-b.
elevatedbloodsugar.
c. infectionatthecathetersite.
d. volumeoverload.
5.Whichofthefollowingstatementsistrueaboutinsulinandparenteralnutrition?
(Selectallthatapply.) - ANSWERS-a.
Amountofparenteralinsulinisadjustedbasedontheprevious24-hourlaboratoryvalues.
b. Insulinmaybeaddedtoaparenteralnutritionsolution.
c. Subcutaneousinsulinisusedonaslidingscaleduringparenteralnutrition.
, Thecorrectorderofactionsforapatientstartingenteralnutritionwithafeedingtubeis:__ -
ANSWERS-A.Initiatetubefeeding. B.Insertfeedingtube. C.Flushtubetoverifypatency.
D.Obtainchestradiograph. E.Assessresiduals. ANS: B,D,C,A,E
1.Apatienthascoronaryarterybypassgraftsurgeryandistransportedtothesurgicalintensivec
areunitatnoon.Heisplacedonmechanicalventilation.Interprethisinitialarterialbloodgaslevel
s:
pH7.31
PaCO248mmHg
Bicarbonate22mEq/L
PaO2115mmHg
O2saturation99% - ANSWERS-d. Uncompensated
respiratory
acidosis;
hyperoxygenated
2.Thephysicianordersthefollowingmechanicalventilationsettingsforapatientwhoweighs75
kg.Thepatientsspontaneousrespiratoryrateis22breaths/
min.Whatarterialbloodgasabnormalitymayoccurifthepatientcontinuestobetachypneicatthe
seventilatorsettings?
Settings:
Tidalvolume:600mL(8mLperkg)
FiO2:0.5
Respiratoryrate:14breaths/min
Modeassist/ control - ANSWERS-d. Respiratoryalkalosis
3.Apatientsventilatorsettingsareadjustedtotreathypoxemia.Thefractionofinspiredoxygenis
increasedfrom.60to.70,andthepositiveend-
expiratorypressureisincreasedfrom10to15cmH2O.Shortlyaftertheseadjustments,thenurs
enotesthatthepatientsbloodpressuredropsfrom120/76mmHgto90/60mmHg.Whatisthemo
stlikelycauseofthisdecreaseinbloodpressure? - ANSWERS-a. Decrease in cardiac
output
4.Thenurseiscaringforapatientwithanendotrachealtube.Thenurseunderstandsthatendotra
chealsuctioningisneededtofacilitateremovalofsecretionsandthattheprocedure: -
ANSWERS-c. is done as indicated by patient assessment.
5.A65-year-oldpatientisadmittedtotheprogressivecareunitwithadiagnosisofcommunity-
acquiredpneumonia.Thepatienthasahistoryofchronicobstructivepulmonarydiseaseanddia
betes.Asetofarterialbloodgasesobtainedonadmissionwithoutsupplementaloxygenshowsp
H7.35;PaCO255mmHg;bicarbonate30mEq/L;PaO265mmHg.Thesebloodgasesreflect: -
ANSWERS-hypoxemia and compensated respiratory acidosis
6.Apatientsstatusworsensandneedsmechanicalventilation.Thepulmonologistwantsthepat
ienttoreceive10breaths/
minfromtheventilatorbutwantstoencouragethepatienttobreathespontaneouslyinbetweent
hemechanicalbreathsathisowntidalvolume.Thismodeofventilationiscalled: - ANSWERS-
c. intermittent mandatory ventilation
7.Apatientsendotrachealtubeisnotsecuredtightly.Therespiratorycarepractitionerassiststh
enurseintapingthetube.Afterthetubeisretaped,thenurseauscultatesthepatientslungsandn
otesthatthebreathsoundsovertheleftlungfieldsareabsent.Thenursesuspectsthat: -
ANSWERS-a. the endotracheal tube is in the right main stem bronchus.
