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1. A 30-year-old man’s diet consists of 3000 calories with 120 g of protein, 160 g of fat, and 270 g of carbohydrate. He weighs 176 lb and is 5 ft, 11 in tall.
a. In the table below, indicate what percentage of total calories each of the nutrients contributes to this man’s diet.
Nutrient Percentage of Total Calories from Nutrient Protein
Fat
Carbohydrates
b. How many calories would be recommended for him as an average adult?
c. Using MyPlate as a guide, what changes could the nurse suggest to bring the man’s diet more in line with nutrition recommendations?
2. Which statement accurately describes vitamin deficiencies?
a. The two nutrients most often lacking in the diet of a vegan are vitamin B6 and folic acid.
b. Vitamin imbalances occur frequently in the United States because of excessive fat intake.
c. Surgery on the GI tract may contribute to vitamin deficiencies because of impaired absorption.
d. Vitamin deficiencies in adults most commonly are clinically manifested by disorders of the skin.
3. What is the most common cause of secondary protein-calorie malnutrition in the United States?
a. The unavailability of foods high in protein b. A lack of knowledge about nutritional needs c. A lack of money to purchase high-protein foods
d. An alteration in ingestion, digestion, absorption, or metabolism
4. Describe the metabolism of nutrients used for energy during starvation within the given approximate time frames.
Time Frame Metabolism of Nutrients First 18 hours
18 hours to 5 to 9 days 9 days to 6 weeks Over 6 weeks
5. What may occur with failure of the sodium-potassium pump during severe protein depletion?
a. Ascites c. Hyperkalemia
b. Anemia d. Hypoalbuminemia
6. What contributes to increased protein-calorie needs?
a. Surgery c. Lowered temperature
b. Vegan diet d. Cultural or religious beliefs
7. During assessment of the patient with protein-calorie malnutrition, what should the nurse expect to find (select all that apply)?
a. Frequent cold symptoms d. A flat or concave abdomen
b. Decreased bowel sounds e. Prominent bony structures
c. Cool, rough, dry, scaly skin f. Decreased reflexes and lack of attention
Nursing Management:
172 Chapter 40 Nursing Management: Nutritional Problems
8. Which patient has the highest risk for poor nutritional balance related to decreased ingestion?
a. Tuberculosis infection c. Draining decubitus ulcers
b. Malabsorption syndrome d. Severe anorexia resulting from radiation therapy 9. The nurse monitors the laboratory results of the patient with protein-calorie malnutrition during treatment. Which
result is an indication of improvement in the patient’s condition?
a. Decreased lymphocytes c. Increased serum transferrin b. Increased serum potassium d. Decreased serum prealbumin
10. To evaluate the effect of nutritional interventions for a patient with protein-calorie malnutrition, what is the best indicator for the nurse to use?
a. Height and weight c. Weight in relation to ideal body weight
b. Body mass index (BMI) d. Mid-upper arm circumference and triceps skinfold 11. The nurse evaluates that patient teaching about a high-calorie, high-protein diet has been effective when the patient
selects which breakfast option from the hospital menu?
a. Two poached eggs, hash brown potatoes, and whole milk
b. Two slices of toast with butter and jelly, orange juice, and skim milk c. Three pancakes with butter and syrup, two slices of bacon, and apple juice
d. Cream of wheat with 2 tbsp of skim milk powder, one half grapefruit, and a high-protein milkshake 12. When teaching the older adult about nutritional needs during aging, what does the nurse emphasize?
a. Need for all nutrients decreases as one ages.
b. Fewer calories, but the same or slightly increased amount of protein, are required as one ages.
c. Fats, carbohydrates, and protein should be decreased, but vitamin and mineral intake should be increased.
d. High-calorie oral supplements should be taken between meals to ensure that recommended nutrient needs are met.
13. When planning nutritional interventions for a healthy 83-year-old man, the nurse recognizes what factor is most likely to affect his nutritional status?
a. Living alone on a fixed income c. An increase in GI motility and absorption b. Changes in cardiovascular function d. Snacking between meals, resulting in obesity 14. When considering tube feedings for a patient with severe protein-calorie malnutrition, what is an advantage of a
gastrostomy tube versus a nasogastric (NG) tube?
a. There is less irritation to the nasal and esophageal mucosa.
b. The patient experiences the sights and smells associated with eating.
c. Aspiration resulting from reflux of formulas into the esophagus is less common.
d. Routine checking for placement is not required because gastrostomy tubes do not become displaced.
15. Identify one nursing intervention indicated for each of the following desired outcomes of tube feeding.
Desired Outcome Nursing Intervention Prevention of aspiration
Prevention of diarrhea Maintenance of tube patency Maintenance of tube placement Administration of medication
16. Priority Decision: Before administering a bolus of intermittent tube feeding to a patient with a percutaneous endoscopic gastrostomy (PEG), the nurse aspirates 220 mL of gastric contents. How should the nurse respond?
a. Return the aspirate to the stomach and recheck the volume of aspirate in an hour.
b. Return the aspirate to the stomach and continue with the tube feeding as planned.
c. Discard the aspirate to prevent overdistending the stomach when the new feeding is given.
d. Notify the health care provider that the feedings have been scheduled too frequently to allow for stomach emptying.
Chapter 40 Nursing Management: Nutritional Problems 173 17. Delegation Decision: Indicate whether the following nursing actions must be performed by the RN or if they can be
delegated to unlicensed assistive personnel (UAP).
a. Insert NG tube for stable patients.
b. Weigh the patient receiving enteral feedings.
c. Teach the patient about home gastric tube care.
d. Remove an NG tube.
e. Provide oral care to the patient with an NG tube.
f. Position patient receiving enteral feedings.
g. Monitor a patient with continuous feeding for complications.
h. Respond to infusion pump alarm by reporting it to an RN or licensed practical nurse (LPN).
18. Indicate whether the following characteristics of parenteral nutrition apply more to central parenteral nutrition (CPN) or peripheral parenteral nutrition (PPN).
a. Limited to 20% glucose b. Tonicity of 1600 mOsm/L
c. Nutrients can be infused using smaller volumes d. Supplements oral feedings
e. Long-term nutritional support f. Phlebitis more common
g. May use peripherally inserted central catheter (PICC)
19. What is an indication for parenteral nutrition that is not an appropriate indication for enteral tube feedings?
a. Head and neck cancer c. Malabsorption syndrome
b. Hypermetabolic states d. Protein-calorie malnutrition
20. What nursing interventions are indicated during parenteral nutrition to prevent the following complications?
Complication Preventive Measure Infection
Hyperglycemia Air embolism
21. Priority Decision: The nurse is caring for a patient receiving 1000 mL of parenteral nutrition solution over 24 hours.
When it is time to change the solution, 150 mL remain in the bottle. What is the most appropriate action by the nurse?
a. Hang the new solution and discard the unused solution.
b. Open the IV line and rapidly infuse the remaining solution.
c. Notify the health care provider for instructions regarding the infusion rate.
d. Wait to change the solution until the remaining solution infuses at the prescribed rate.
22. Identify the following characteristics of eating disorders as being associated with anorexia nervosa (A), bulimia (B), or both (AB).
a. Treated with psychotherapy b. Ignores feelings of hunger c. Binge eating with purging d. Conceals abnormal eating habits e. Concerned about body image f. Self-induced starvation g. Compulsive exerciser
h. Broken blood vessels in the eyes
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23. Priority Decision: An 18-year-old female patient with anorexia nervosa is admitted to the hospital for treatment.
On admission she weighs 82 lb (37 kg) and is 5 ft, 3 in (134.6 cm). Her laboratory test results include the following:
K+ 2.8 mEq/L (2.8 mmol/L), Hgb 8.9 g/dL (89 g/L), and BUN 64 mg/dL (22.8 mmol/L). In planning care for the patient, the nurse gives the highest priority to which of the following nursing diagnoses?
a. Risk for injury related to dizziness and weakness resulting from anemia
b. Imbalanced nutrition: less than body requirements related to inadequate food intake c. Risk for impaired urinary elimination related to elevated BUN resulting from renal failure d. Risk for decreased cardiac output (CO) related to dysrhythmias resulting from hypokalemia
CASE STUDY Malnutrition Patient Profile
R.M., a 62-year-old Hispanic widow, recently underwent radiation and chemotherapy following surgery for breast cancer. On a follow-up visit to the clinic, the nurse notes that R.M. appears thinner and more tired than usual.
Subjective Data
• Says she has not had an appetite since the treatment for cancer was started
• Feels “weak” and “worn out”
• Thinks the treatment for cancer has not been effective
• Lives alone in an apartment in the inner city
• Is a naturalized citizen from Honduras
• Speaks English but does not read English very well Objective Data
Physical Examination
• Height: 5 ft, 2 in (155 cm)
• Weight: 92 lb (41.8 kg)
• Vital signs: BP 98/60, HR 60 bpm, RR 12
• Ulcerations of her buccal mucosal membranes and tongue Laboratory Tests
• Serum albumin: 2.8 g/dL (28 g/L)
• Hgb: 10 g/dL (100 g/L)
• Hct: 32%
Discussion Questions
Using a separate sheet of paper, answer the following questions:
1. What additional assessment data should the nurse obtain from R.M. related to her nutritional status?
2. What physical and psychosocial factors have contributed to R.M.’s malnutrition?
3. What additional symptoms would the nurse expect to see based on R.M.’s laboratory test results?
4. What complications of malnutrition are most likely to occur in R.M. because of her history and clinical manifestations?
5. Priority Decision: What are the priority teaching instructions that the nurse should give to R.M. regarding her diet that would be most therapeutic?
6. Priority Decision: Based on the assessment data presented, what are the priority nursing diagnoses? Are there any collaborative problems?
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