Chapter 040

Lewis: Medical-Surgical Nursing, 7th Edition
Test Bank
Chapter 40: Nursing Management: Nutritional Problems
MULTIPLE CHOICE
1. An 82-year-old Latino patient with mild protein-calorie malnutrition shares a home

with his spouse and adult daughter. When developing a teaching plan to improve the
patient’s nutrition, it will be most important for the nurse to obtain information about
a. food preferences of the spouse and adult child.
b. who shops for groceries and cooks.
c. the number of meals per day the patient eats.
d. foods that are culturally significant for the patient.
Correct Answer: B
Rationale: The family member who shops for groceries and cooks will be in control of
the patient’s diet, so the nurse will need to ensure that this family member is involved in
any teaching or discussion about the patient’s nutritional needs. The other information
will also be assessed and used but will not be useful in meeting the patient’s nutritional
needs unless nutritionally appropriate foods are purchased and prepared.
Cognitive Level: Application Text Reference: p. 951

Nursing Process: Planning
NCLEX: Health Promotion and Maintenance
2. A patient who weighs 145 pounds (66 kg) asks the nurse how much protein should be
included in the daily diet. The nurse recommends that the diet should include a
minimum of _____ g protein.
a. 36
b. 53
c. 75
d. 98
Correct Answer: B
Rationale: 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 for this patient.

Nursing Process: Implementation
NCLEX: Health Promotion and Maintenance
Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Test Bank 40-2
3. During assessment of a patient who is a vegan, the nurse observes for signs of
nutritional deficiency. The most common nutritional deficiency related to a strict
vegan diet would be manifested by
a. muscle wasting.
b. bleeding gums.
c. pallor and changes in sensation and movement of the extremities.
d. dry, scaly skin and cracked, painful oral mucous membranes.
Correct Answer: C
Rationale: Cobalamin (vitamin B12) cannot be obtained in foods of plant origin, so the
patient will be most at risk for signs of cobalamin deficiency, such as anemia and
peripheral neuropathy. The other symptoms listed are associated with other nutritional
deficiencies but would not be associated with a vegan diet.
Cognitive Level: Application Text Reference: pp. 950-951

Nursing Process: Assessment NCLEX: Physiological Integrity
4. The nurse teaches a patient who is being stabilized on a therapeutic dose of warfarin
(Coumadin) not to alter the normal dietary intake of green, leafy vegetables, dairy
products, or meats, primarily because these foods
a. are a source of vitamin K and may alter the action of warfarin.
b. decrease the absorption of warfarin.
c. have a natural anticoagulant effect.
d. affect the activity of bowel bacteria responsible for vitamin K production.
Correct Answer: A
Rationale: Because warfarin activity is affected by the level of vitamin K, the patient’s
intake of vitamin K-rich foods should be consistent. The absorption of warfarin is not
affected by these foods. The foods do not have an anticoagulant effect or impact on the
bowel bacteria activity.

Nursing Process: Implementation NCLEX: Physiological Integrity
5. A 72-year-old patient with massive infection is 5 ft 2 in (155 cm) tall and weighs 92
pounds (42 kg). Laboratory results include hemoglobin 10.5 g/dl (105 g/L) and
albumin 2.0 g/dl (20 g/L). Which additional information will be most useful when the
nurse is determining the patient’s nutritional status?
a. Blood pressure
b. Level of consciousness
c. Presence of edema
d. Food allergies
Correct Answer: C

Test Bank 40-3
Rationale: Edema occurs when serum albumin levels and plasma oncotic pressure
decrease, as occurs when a stressor such as infection is imposed on pre-existing poor
nutritional status. The blood pressure and level of consciousness are not directly affected
by protein-calorie malnutrition. Food allergies are not an indicator of nutritional status.
Cognitive Level: Application Text Reference: pp. 952, 956

6. When using a nutrition screening tool, the nurse can identify a patient at nutritional
risk without further assessment when the patient has
a. pressure ulcers.
b. had a recent hip fracture.
c. been vomiting for 3 days.
d. had recent surgery.
Correct Answer: A
Rationale: Malnutrition is a major risk factor for pressure ulcers; therefore, the presence
of a pressure ulcer indicates that the patient is at nutritional risk. The other patient
diagnoses are not independent risk factors for poor nutrition.
Cognitive Level: Comprehension Text Reference: p. 957

7. In evaluating a patient outcome of “chooses high-protein foods,” the nurse knows the
outcome has been met when for lunch the patient selects from the hospital menu
a. bacon and tomato sandwich, bean soup, and coffee with cream.
b. peanut butter and jelly sandwich, French fries, and whole milk.
c. barbequed chicken breast sandwich, fruit yogurt, and skim milk.
d. chicken noodle soup, grilled cheese sandwich, and apple juice.
Correct Answer: C
Rationale: The poultry and dairy selected are all high in complete protein. Although the
other responses have some high protein foods, they are not as high in protein.

Nursing Process: Evaluation NCLEX: Physiological Integrity
8. A high-calorie, high-protein diet is provided for a patient with a fractured hip and
severe protein-calorie depletion, but the patient eats only about 50% of each meal tray
and then complains of feeling tired. The nurse will plan to
a. arrange for smaller portions to be served on patient trays.
b. serve multiple small feedings of high-calorie, high-protein foods.
c. give continuous tube feedings of liquid nutritional supplements.

Test Bank 40-4
d. administer intravenous feeding with parenteral nutrition solutions.
Correct Answer: B
Rationale: Eating small amounts of food frequently throughout the day is less fatiguing
and will improve the patient’s ability to take in more nutrients. Smaller serving sizes will
not improve patient nutritional intake. Tube feedings or parenteral nutrition (PN) may be
needed if the patient is unable to take in enough nutrients orally, but increasing the oral
intake should be attempted first.

Nursing Process: Planning NCLEX: Physiological Integrity
9. While caring for an older adult patient hospitalized with dehydration and moderate
protein-calorie malnutrition (PCM), the nurse identifies a nursing diagnosis of risk for
infection related to
a. decreased leukocyte activity and phagocytosis.
b. anemia of malnutrition.
c. muscle weakness and impaired coughing effort.
d. delayed wound healing.
Correct Answer: A
Rationale: The patient’s moderate PCM will decrease leukocyte activity and
phagocytosis. A decrease in red blood cells (RBCs) does not increase risk for infection.
Muscle wasting is a sign of more severe PCM. The patient does not have any open
wounds.

Nursing Process: Diagnosis NCLEX: Physiological Integrity
10. A 66-year-old patient recovering from surgery for cancer of the lung is thin and has
an albumin level of 3.7 g/dl (37 g/L). The nurse will plan to teach the patient about
a. the need to increase protein intake during the patient’s hospitalization period.
b. the requirement for high-protein and high-calorie foods for at least several weeks.
c. selecting foods that are high in protein but relatively low in calories.
d. picking protein-rich foods that are also low in calories derived from fat.
Correct Answer: B
Rationale: After major surgery, the patient will require high-protein and high-caloric
intake for several weeks to promote wound healing and decrease infection risk. Teaching
the patient to increase protein during hospitalization will not meet the patient’s needs
during the entire time required for wound healing. The patient needs increases in both
calories and protein. Fat is the best source of calories and should not be restricted when
the goal is a high-calorie intake.

Test Bank 40-5

11. A patient with difficulty swallowing is started on continuous tube feedings of a full-
strength commercial formula at 100 ml/hr. The patient has six diarrhea stools the first
day. The action that is most appropriate for the nurse to take first is to
a. slow the tube feeding flow rate.
b. discontinue any water intake.
c. notify the health care provider about the need for a change in formula.
d. check residuals and hold feedings if any residual is found.
Correct Answer: A
Rationale: Loose stools indicate poor absorption of nutrients and indicate a need to slow
the feeding rate or decrease the concentration of the feeding. Water will dilute the feeding
and improve absorption. Also, many supplemental feedings will cause dehydration unless
water is administered in addition to the feeding. The nurse may notify the health care
provider about the loose stools, but actions such as slowing the feeding will be initially
used rather than changing the formula of the feeding. High residual volumes do not
contribute to diarrhea.

12. A patient is receiving continuous tube feedings through a percutaneous endoscopic

gastrostomy (PEG). To maintain safe and effective delivery of the tube feeding, the
nurse should
a. flush the tube with 50 ml of water every 8 hours after checking for residual
volume.
b. obtain a daily radiograph for verification of tube placement.
c. check tube placement and residual volume every 4-6 hours.
d. place the patient on the left side with the head of the bed elevated to 45 degrees.
Correct Answer: C
Rationale: The tube placement and residual volume are assessed every 4 hours to ensure
that the tube is correctly positioned and decrease the risk for aspiration. The amount of
water needed depends on the type of formula being administered. An x-ray is obtained
immediately after placement of the PEG tube to check position, but daily radiographs are
not needed. The patient should have the head elevated 30 to 45 degrees but does not need
to be continuously on the left side.


Test Bank 40-6
13. Parenteral nutrition (PN) containing amino acids and dextrose was ordered and hung
24 hours ago for a malnourished patient. The nurse observes that about 50 ml
remaining in the PN container. Which action is appropriate at this time?
a. Infuse the remaining 50 ml and then hang a new container of PN.
b. Hang a new container of PN and change the IV tubing and filter.
c. Continue to use the same tubing and filter and hang a new container of PN.
d. Clarify with the health care provider if the new PN also requires a tubing and filter
change.
Correct Answer: C
Rationale: 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.

14. PN with a peripherally inserted central catheter (PICC) is initiated for a patient. After
6 hours of PN infusion, the nurse checks the patient’s capillary blood glucose level
and finds it to be 140 mg/dl (8.9 mmol/L). The most appropriate action by the nurse is
to
a. notify the health care provider of the glucose level.
b. recheck the capillary blood glucose in 4 hours.
c. obtain a venous blood glucose specimen.
d. slow the infusion rate of the PN infusion.
Correct Answer: B
Rationale: 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,
the health care provider is not notified. There is no need to obtain a venous specimen for
comparison. Slowing the rate of the infusion is beyond the nurse’s scope of practice and
will decrease the patient’s nutritional intake.

15. A patient with protein-calorie malnutrition has undergone surgery and radiation
therapy for a malignant tumor of the bowel. The health care provider orders PN for
the patient. The nurse will evaluate that the PN is effective when the patient’s
a. blood glucose is 110 mg/dl.
b. fluid intake and output are balanced.

Test Bank 40-7
c. surgical incision is healing normally.

d. serum albumin level is 3.7 mg/dl.
Correct Answer: C
Rationale: 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 patient’s nutrition is
adequate. The intake and output will be monitored but do not indicate that the PN is
effective. The albumin level is low normal but does not reflect adequate caloric intake,
which is also important for the patient.

Nursing Process: Evaluation NCLEX: Physiological Integrity
16. The hospital nurse educator is observing a new RN who is caring for a patient
receiving PN through a single-lumen central line inserted in the right subclavian vein.
Which action by the new RN indicates that the RN can safely care for the patient?
a. The new RN flushes the line after drawing a blood specimen.
b. The new RN reminds the patient to keep the right arm straight.
c. The new RN checks capillary blood glucose every 8 hours.
d. The new RN infuses the PN solution using an infusion pump.
Correct Answer: D
Rationale: An infusion pump is used for PN administration. A single-lumen catheter
should not be used to draw blood because of the risk for infection or clotting. There is no
need to keep the arm straight when a central line is in place. The capillary blood glucose
is checked every 4 to 6 hours.

Nursing Process: Evaluation
NCLEX: Safe and Effective Care Environment
17. A 22-year-old patient is admitted to the hospital with anorexia nervosa. The patient is
5 ft 5 in (163 cm) tall and weighs 90 pounds (41 kg). Laboratory tests reveal
hypokalemia and iron-deficiency anemia. In planning care for the patient, the nurse
places the highest priority on the nursing diagnosis of
a. ineffective health maintenance related to obsession with body image.
b. risk for decreased cardiac output related to electrolyte imbalance.
c. imbalanced nutrition: less than body requirements related to refusal to eat.
d. risk for activity intolerance related to anemia and weakness.
Correct Answer: B

Test Bank 40-8
Rationale: The patient’s hypokalemia may lead to life-threatening cardiac dysrhythmias.

The other diagnoses are also appropriate for this patient but are not associated with risk
for decreased cardiac output or death.

18. A patient with bulimia is admitted to the hospital with electrolyte disorders. Which
patient behavior observed by the nurse is of most concern?
a. The patient only eats about 20% of breakfast.
b. The patient ambulates continuously in the hallway.
c. The patient goes into the bathroom after each meal.
d. The patient asks for laxatives to treat constipation.
Correct Answer: C
Rationale: Self-induced vomiting after eating is a hallmark of bulimia and may lead to
further electrolyte disturbances and associated problems such as cardiac dysrhythmias.
The other behaviors are also characteristic of patients with bulimia but do not pose an
immediate threat to the patient’s physiologic status.

19. All these nursing actions are included in the plan of care for a patient who is
malnourished. Which action is appropriate for the nurse to delegate to a nursing
assistant?
a. Offer the patient the ordered nutritional supplement between meals.
b. Assess the patient’s strength while ambulating the patient in the room.
c. Monitor the patient for skin breakdown over the bony prominences.
d. Assist the patient to choose high-nutrition items from the menu.
Correct Answer: A
Rationale: Feeding the patient and assisting with oral intake are included in nursing
assistant education and scope of practice. Assessing the patient and assisting the patient in
choosing high nutrition foods require LPN/LVN- or RN-level education and scope of
practice.


Test Bank 40-9
20. A patient who has a wound infection after major surgery has only been taking in
about 50% to 75% of the ordered meals and states, “Nothing on the menu really
appeals to me.” Which action by the nurse will be most effective in improving the
patient’s oral intake?
a. Order at least six small meals daily.
b. Have family members bring in favorite foods from home.
c. Teach the patient about high-calorie, high-protein foods.
d. Make a referral to the dietician.
Correct Answer: B
Rationale: The patient’s statement that the hospital foods are unappealing indicates that
favorite home-cooked foods might improve intake. The other interventions may also help
improve the patient’s intake, but the most effective action will be to offer the patient more
appealing foods.

21. When using a soft, silicone nasogastric tube for enteral feedings, the nurse will need
to
a. flush the tubing after checking for residual volumes.
b. administer continuous feedings using an infusion pump.
c. replace the tube every 3 to 5 days to avoid mucosal damage.
d. avoid giving medications through the feeding tube.
Correct Answer: A
Rationale: 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.

22. A patient who is receiving a continuous tube feeding through a small-bore silicone
feeding tube has a computed tomography (CT) scan ordered and will have to be
placed in a flat position for the scan. The nurse will plan to
a. ask the health care provider to reschedule the CT scan.
b. send the patient to CT scan with oral suction in case of aspiration.
c. shut the feeding off 30 to 60 minutes before the scan.
d. connect the feeding tube to continuous suction during the scan.

Test Bank 40-10
Correct Answer: C
Rationale: 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.

23. Which of these nursing actions included in the plan of care for a patient who is
receiving intermittent tube feedings through a PEG tube may be delegated to an
LPN/LVN?
a. Teaching the patient and family how to administer tube feedings
b. Assessing the patient’s nutritional status at least weekly
c. Determining the need for the addition of water to the feedings
d. Providing skin care to the area around the tube site
Correct Answer: D
Rationale: 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 RN-level education and scope of practice.

24. The nurse notes that the peripheral PN bag is almost empty and a new PN bag has not
yet arrived from the pharmacy. Which action is appropriate?
a. Decreasing the rate of the current PN infusion to 10 ml/hr until the new bag arrives
b. Infusing 5% dextrose in water until the new PN bag is delivered from the
pharmacy
c. Flushing the peripheral line with saline and wait until the new PN bag is available
d. Monitoring the patient’s capillary blood glucose until a new PN bag is hung
Correct Answer: B
Rationale: 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 nurse’s 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 an adequate response because monitoring


Test Bank 40-11
MULTIPLE RESPONSE
1. During a busy day, the nurse admits all of these patients to the medical-surgical unit.
Which patients are most important to refer to the dietician for a complete nutritional
assessment? (Select all that apply.)
a. A 24-year-old admitted with multiple leg fractures after an automobile accident
b. A 32-year-old admitted for eye surgery and has a history of diabetes
c. A 45-year-old admitted with chest pain and possible myocardial infarction (MI)
d. A 53-year-old who complains of intermittent nausea for the past 2 days
e. A 66-year-old who is admitted for débridement of an infected surgical wound
Correct Answer: A, B, E
Rationale: Multiple fractures, diabetes, and poor wound healing are diagnoses that place
the patient at nutritional risk. 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.

OTHER
1. While caring for a comatose patient who is receiving continuous tube feedings
through a soft nasogastric tube, the nurse notes the presence of new crackles in the
patient’s lungs. In which order will the nurse take the following actions?
a. Obtain the patient’s oxygen saturation.
b. Turn off the tube feeding.
c. Notify the patient’s health care provider.
d. Check the tube feeding residual volume.
Correct Answer: B, A, D, C
Rationale: The assessment data indicate that aspiration may have occurred, and the
nurse’s 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.


Chapter 040

Încărcat de

Informații document

Drepturi de autor

Formate disponibile

Partajați acest document

Partajați sau inserați document

Opțiuni de partajare

Vi se pare util acest document?

Este necorespunzător acest conținut?

Drepturi de autor:

Formate disponibile

Chapter 040

Încărcat de

Drepturi de autor:

Formate disponibile

Lewis: Medical-Surgical Nursing, 7th Edition

Chapter 40: Nursing Management: Nutritional Problems

1. An 82-year-old Latino patient with mild protein-calorie malnutrition shares a home

Cognitive Level: Application Text Reference: p. 951

Cognitive Level: Application Text Reference: p. 949

Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Cognitive Level: Application Text Reference: pp. 950-951

Cognitive Level: Application Text Reference: p. 954

Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Cognitive Level: Application Text Reference: pp. 952, 956

Cognitive Level: Comprehension Text Reference: p. 957

Cognitive Level: Application Text Reference: p. 950

Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

d. administer intravenous feeding with parenteral nutrition solutions.

Cognitive Level: Application Text Reference: p. 958

Cognitive Level: Application Text Reference: p. 954

Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Cognitive Level: Application Text Reference: p. 958

Cognitive Level: Application Text Reference: pp. 963-964

12. A patient is receiving continuous tube feedings through a percutaneous endoscopic

Cognitive Level: Application Text Reference: p. 963

Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Cognitive Level: Application Text Reference: p. 966

Cognitive Level: Application Text Reference: p. 967

Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

c. surgical incision is healing normally.

Cognitive Level: Application Text Reference: p. 954

Cognitive Level: Application Text Reference: p. 967

Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Rationale: The patient’s hypokalemia may lead to life-threatening cardiac dysrhythmias.

Cognitive Level: Application Text Reference: p. 969

Cognitive Level: Application Text Reference: p. 968

Cognitive Level: Application Text Reference: pp. 955-959

Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Cognitive Level: Application Text Reference: p. 958

Cognitive Level: Application Text Reference: p. 961

Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Cognitive Level: Application Text Reference: p. 963

Cognitive Level: Application Text Reference: pp. 967-968

Cognitive Level: Application Text Reference: p. 967

Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Cognitive Level: Application Text Reference: p. 957

Cognitive Level: Application Text Reference: p. 963

Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

S-ar putea să vă placă și