Chapter 06: Nutritional Support

Chapter 06: Nutritional Support

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

MULTIPLE CHOICE

 

1. A patient is having complications from abdominal surgery and remains NPO. Because enteral tube feedings are not possible, the decision is to initiate parenteral feedings. What are the major complications for this therapy?

a.	Aspiration pneumonia and sepsis
b.	Sepsis and fluid and electrolyte imbalances
c.	Fluid overload and pulmonary edema
d.	Hypoglycemia and renal insufficiency

 

 

ANS:  B

Because of the high dextrose concentration, including the fluid and electrolyte content, the patient is placed at high risk for sepsis and fluid and electrolyte imbalances. Aspiration pneumonia is a potential complication of enteral feedings; sepsis is a potential complication of parenteral nutrition. Fluid overload is possible but unlikely and is not a major complication of parenteral nutrition. Hyperglycemia is more of a concern than hypoglycemia with parenteral nutrition; however, renal insufficiency is not related to parenteral nutrition.

 

DIF:    Cognitive Level: Remember/Knowledge                           REF:   p. 85

OBJ:   Describe strategies for monitoring and evaluating the nutrition care plan.

TOP:   Nursing Process Step: Assessment

MSC:  NCLEX Client Needs Category: Physiological Integrity

 

2. A patient is being ventilated and has been started on enteral feedings with a nasogastric small-bore feeding tube. What is the primary reason the nurse must frequently assess tube placement?

a.	To assess for paralytic ileus
b.	To maintain the patency of the feeding tube
c.	To monitor for skin breakdown on the nose
d.	To prevent aspiration of the feedings

 

 

ANS:  D

Patients who are on a ventilator and who are receiving tube feedings are at a high risk for aspiration and ventilator-associated pneumonia. Assessment of tube placement will neither determine presence of paralytic ileus nor maintain patency. Assessment of tube placement is performed to minimize aspiration risk, not skin breakdown on the nose.

 

DIF:    Cognitive Level: Remember/Knowledge                           REF:   p. 85 | Table 6-4

OBJ:   Describe strategies for monitoring and evaluating the nutrition care plan.

TOP:   Nursing Process Step: Assessment

MSC:  NCLEX Client Needs Category: Physiological Integrity

 

3. The patient is to start parenteral nutrition. The nurse knows to prepare which site for catheter insertion?

a.	Basilic vein
b.	Femoral vein
c.	Radial artery
d.	Subclavian vein

 

 

ANS:  D

Total parenteral nutrition is administered through a central intravenous line, such as the subclavian vein. Arteries are never used. The femoral site is avoided. The basilic vein is not a central site.

 

DIF:    Cognitive Level: Remember/Knowledge                           REF:   p. 80

OBJ:   Discuss practice guidelines related to nutritional support.

TOP:   Nursing Process Step: Implementation

MSC:  NCLEX Client Needs Category: Physiological Integrity

 

4. A patient has been admitted to the critical care unit after a stroke. After “failing” a swallow study, the patient is placed on enteral feedings. Following placement of a nasogastric tube for tube feeding, what is the next critical step?

a.	Administer medications.
b.	Cap off and wait 24 hours before starting feedings.
c.	Obtain a chest radiograph.
d.	Start the tube feeding.

 

 

ANS:  C

Correct placement must be verified by radiograph before use of the tube for either feeding or administering medications. There is no reason to cap the tube and wait; once placement is verified, the tube can be used.

 

DIF:    Cognitive Level: Apply/Application                                  REF:   p. 86 | Table 6-4

OBJ:   Discuss practice guidelines related to nutritional support.

TOP:   Nursing Process Step: Planning

MSC:  NCLEX Client Needs Category: Physiological Integrity

 

5. A critically ill patient has a nonhealing wound and malnutrition. Which component of nutritional supplementation is most important for this patient to receive?

a.	Arginine
b.	Omega-3 fatty acids
c.	Branched-chain amino acids
d.	Vitamin A

 

 

ANS:  D

Vitamin A is vital for wound healing. Arginine is also important in wound healing but is more important for trauma and septic patients, as are omega-3 fatty acids. Branched-chain amino acids are very important for stressed patients who have liver dysfunction or ARDS.

 

DIF:    Cognitive Level: Remember/Knowledge                           REF:   p. 82 | Table 6-1

OBJ:   Discuss practice guidelines related to nutritional support.

TOP:   Nursing Process Step: Implementation

MSC:  NCLEX Client Needs Category: Physiological Integrity