Deck 60: Care of Patients with Malnutrition: Undernutrition and Obesity

Question 1

A client is receiving total parenteral nutrition (TPN).On assessment,the nurse notes the client's pulse is 128 beats/min,blood pressure is 98/56 mm Hg,and skin turgor is dry.What action should the nurse perform next?

A) Assess the 24-hour fluid balance.
B) Assess the client's oral cavity.
C) Prepare to hang a normal saline bolus.
D) Turn up the infusion rate of the TPN.

Answer 1

Assess the 24-hour fluid balance.

Question 2

A nurse is caring for a morbidly obese client.What comfort measure is most important for the nurse to delegate to the unlicensed assistive personnel (UAP)?

A) Designating "quiet time" so the client can rest
B) Ensuring siderails are not causing excess pressure
C) Providing oral care before and after meals and snacks
D) Relaying any reports of pain to the registered nurse

Answer 2

Ensuring siderails are not causing excess pressure

Question 3

A nurse is caring for four clients receiving enteral tube feedings.Which client should the nurse see first?

A) Client with a blood glucose level of 138 mg/dL
B) Client with foul-smelling diarrhea
C) Client with a potassium level of 2.6 mEq/L
D) Client with a sodium level of 138 mEq/L

Answer 3

Client with a potassium level of 2.6 mEq/L

Question 4

A client asks the nurse about drugs for weight loss.What response by the nurse is best?

A) "All weight-loss drugs can cause suicidal ideation."
B) "No drugs are currently available for weight loss."
C) "Only over-the-counter medications are available."
D) "There are three drugs currently approved for this."

Question 5

Several nurses have just helped a morbidly obese client get out of bed.One nurse accesses the client's record because "I just have to know how much she weighs!" What action by the client's nurse is most appropriate?

A) Make an anonymous report to the charge nurse.
B) State "That is a violation of client confidentiality."
C) Tell the nurse "Don't look; I'll tell you her weight."
D) Walk away and ignore the other nurse's behavior.

Question 6

A client is awaiting bariatric surgery in the morning.What action by the nurse is most important?

A) Answering questions the client has about surgery
B) Beginning venous thromboembolism prophylaxis
C) Informing the client that he or she will be out of bed tomorrow
D) Teaching the client about needed dietary changes

Question 7

A client is in the family practice clinic.Today the client weighs 186.4 pounds (84.7 kg).Six months ago the client weighed 211.8 pounds (96.2 kg).What action by the nurse is best?

A) Ask the client if the weight loss was intentional.
B) Determine if there are food allergies or intolerances.
C) Perform a comprehensive nutritional assessment.
D) Perform a rapid bedside blood glucose test.

Question 8

A nurse is reviewing laboratory values for several clients.Which value causes the nurse to conduct nutritional assessments as a priority?

A) Albumin: 3.5 g/dL
B) Cholesterol: 142 mg/dL
C) Hemoglobin: 9.8 mg/dL
D) Prealbumin: 28 mg/dL

Question 9

A client has been prescribed lorcaserin (Belviq).What teaching is most appropriate?

A) "Increase the fiber and water in your diet."
B) "Reduce fat to less than 30% each day."
C) "Report dry mouth and decreased sweating."
D) "Lorcaserin may cause loose stools for a few days."

Question 10

A nurse is caring for a client receiving enteral feedings through a Dobhoff tube.What action by the nurse is best to prevent hyperosmolarity?

A) Administer free-water boluses.
B) Change the client's formula.
C) Dilute the client's formula.
D) Slow the rate of infusion.

Question 11

A nurse attempted to assist a morbidly obese client back to bed and had immediate pain in the lower back.What action by the nurse is most appropriate?

A) Ask another nurse to help next time.
B) Demand better equipment to use.
C) Fill out and file a variance report.
D) Refuse to assist the client again.

Question 12

A client is receiving total parenteral nutrition (TPN).What action by the nurse is most important?

A) Assessing blood glucose as directed
B) Changing the IV dressing each day
C) Checking the TPN with another nurse
D) Performing appropriate hand hygiene

Question 13

A client having a tube feeding begins vomiting.What action by the nurse is most appropriate?

A) Administer an antiemetic.
B) Check the client's gastric residual.
C) Hold the feeding until the nausea subsides.
D) Reduce the rate of the tube feeding by half.

Question 14

A nurse and a registered dietitian are assessing clients for partial parenteral nutrition (PPN).For which client would the nurse suggest another route of providing nutrition?

A) Client with congestive heart failure
B) Older client with dementia
C) Client who has multiorgan failure
D) Client who is post gastric resection

Question 15

A client is receiving bolus feedings through a Dobhoff tube.What action by the nurse is most important?

A) Auscultate lung sounds after each feeding.
B) Check tube placement before each feeding.
C) Check tube placement every 8 hours.
D) Weigh the client daily on the same scale.

Question 16

A client tells the nurse about losing weight and regaining it multiple times.Besides eating and exercising habits,for what additional data should the nurse assess as the priority?

A) Economic ability to join a gym
B) Food allergies and intolerances
C) Psychosocial influences on weight
D) Reasons for wanting to lose weight

Question 17

A morbidly obese client is admitted to a community hospital that does not typically care for bariatric-sized clients.What action by the nurse is most appropriate?

A) Assess the client's readiness to make lifestyle changes.
B) Ensure adequate staff when moving the client.
C) Leave siderails down to prevent pressure ulcers.
D) Reinforce the need to be sensitive to the client.

Question 18

A nursing student is studying nutritional problems and learns that kwashiorkor is distinguished from marasmus with which finding?

A) Deficit of calories
B) Lack of all nutrients
C) Specific lack of protein
D) Unknown cause of malnutrition

Question 19

A client is in the bariatric clinic 1 month after having gastric bypass surgery.The client is crying and says "I didn't know it would be this hard to live like this." What response by the nurse is best?

A) Assess the client's coping and support systems.
B) Inform the client that things will get easier.
C) Re-educate the client on needed dietary changes.
D) Tell the client lifestyle changes are always hard.

Question 20

A client just returned to the surgical unit after a gastric bypass.What action by the nurse is the priority?

A) Assess the client's pain.
B) Check the surgical incision.
C) Ensure an adequate airway.
D) Program the morphine pump.

Question 21

When working with older adults to promote good nutrition,what actions by the nurse are most appropriate? (Select all that apply.)

A) Allow uninterrupted time for eating.
B) Assess dentures for appropriate fit.
C) Ensure the client has glasses on when eating.
D) Provide salty foods that the client can taste.
E) Serve high-calorie, high-protein snacks.

Question 22

A nurse has delegated feeding a client to an unlicensed assistive personnel (UAP).What actions does the nurse include in the directions to the UAP? (Select all that apply.)

A) Allow 30 minutes for eating so food doesn't get spoiled.
B) Assess the client's mouth while providing premeal oral care.
C) Ensure warm and cold items stay at appropriate temperatures.
D) Remove bedpans, soiled linens, and other unpleasant items.
E) Sit with the client, making the atmosphere more relaxed.

Question 23

A nurse is designing a community education program to meet the Healthy People 2020 objectives for nutrition and weight status.What information about these goals does the nurse use to plan this event? (Select all that apply.)

A) Decrease the amount of fruit to 1.1 cups/1000 calories.
B) Increase the amount of vegetables to 1.1 cups/1000 calories.
C) Increase the number of adults at a healthy weight by 25%.
D) Reduce the number of adults who are obese by 10%.
E) Reduce the consumption of saturated fat by nearly 10%.

Question 24

A client wants to lose 1.5 pounds a week.After reviewing a diet history,the nurse determines the client typically eats 2450 calories a day.What should the client's calorie goal be to achieve this weight loss? (Record your answer using a whole number.)__ calories/day

Question 25

A client's small-bore feeding tube has become occluded after the nurse administered medications.What actions by the nurse are best? (Select all that apply.)

A) Attempt to dissolve the clog by instilling a cola product.
B) Determine if any of the medications come in liquid form.
C) Flush the tube before and after administering medications.
D) Mix all medications in the formula and use a feeding pump.
E) Try to flush the tube with 30 mL of water and gentle pressure.

Question 26

A client is receiving continuous tube feeding at 70 mL/hr.When the bag is empty,how much formula does the nurse add? (Record your answer using a whole number.)_____ mL

Question 27

A nurse is weighing and measuring a client with severe kyphosis.What is the best method to obtain this client's height?

A) Add the trunk and leg measurements.
B) Ask the client how tall he or she is.
C) Estimate by measuring clothing.
D) Use knee-height calipers.

Question 28

A client weighs 228 pounds (103.6 kg)and is 5'3" (160 cm)tall.What is this client's body mass index (BMI)? (Record your answer using a decimal rounded up to the nearest tenth.)_____

Question 29

The nurse understands that malnutrition can occur in hospitalized clients for several reasons.Which are possible reasons for this to occur? (Select all that apply.)

A) Cultural food preferences
B) Family bringing snacks
C) Increased need for nutrition
D) Need for NPO status
E) Staff shortages