Question 1

The nurse is caring for an obese client who will be taking orlistat (Xenical)to help her lose weight.Which statement indicates that the client understands teaching about orlistat?

Accepted Answer

Orlistat (Xenical)inhibits lipase,leading to partial hydrolysis of triglycerides.Fats are only partially digested and absorbed and are excreted in the feces.The client may experience nausea,cramps,and loose stools when fats are increased in the diet.Orlistat does not increase metabolism,suppress appetite,or make the client feel full after small meals.

Question 2

The nurse is caring for a client who is a vegan and has developed B₁₂ deficiency.Which foods does the nurse encourage the client to include in the diet?

Accepted Answer

Megaloblastic anemia is caused by lack of folic acid and vitamin B₁₂ in the diet.Vegans are susceptible to this and need to include fortified cereals,soy beverages,or meat substitutes in their diets.The other foods listed are not good sources of folic acid and vitamin B₁₂.

Question 3

The nurse is caring for a female client who is 5 feet,7 inches tall and weighs 115 pounds.The client asks the nurse if she needs to lose weight.Which response by the nurse is best?

Accepted Answer

The client's body mass index (BMI)is 18.0,so she is already underweight.It is inaccurate to tell the client she is overweight,and it is unnecessary to consider her weight in light of any cardiovascular risk factors.The nurse should not reassure the client that her weight is just fine because she is underweight.

Question 4

Which dietary adjustments does the nurse recommend to an older adult client asking what changes she should institute to prevent or manage constipation?

Accepted Answer

Older adults are prone to constipation.To manage or prevent constipation,teach the older client to drink eight glasses of water daily and to take in plenty of fiber.These guidelines are good for other clients as well.The other suggestions will not prevent or help manage constipation.

Question 5

The nurse is caring for a client on a limited income who has been diagnosed with kwashiorkor.Which foods does the nurse suggest to improve the client's nutritional status with minimal increase in food costs?

Accepted Answer

Kwashiorkor develops as a result of lack of protein intake despite adequate calories.The client needs to increase protein-containing foods.Eggs and cheese are high-protein foods that are less expensive than meats.Pasta,vegetables,fruit,and oatmeal have less protein than eggs and cheese.

Question 6

The nurse is caring for an overweight client who gained 10 pounds during the previous 2 weeks.The client states that she is hungry all the time and doesn't understand why.Which assessment finding could explain the client's weight gain and hunger?

Accepted Answer

Dexamethasone is a corticosteroid.These drugs alter carbohydrate,protein,and lipid metabolism,predisposing the client to obesity when taken on a long-term basis.In addition,corticosteroids increase the client's appetite.Naprosyn is an NSAID,which can lead to gastric upset and ulceration and decreased appetite and weight loss.The client's glycosylated hemoglobin and thyroid levels are within normal limits and would not explain the hunger and weight gain.

Question 7

Which client is at highest risk for developing dehydration and hypernatremia as a result of enteral feedings?

Accepted Answer

Hypertonic enteral tube feedings can easily lead to dehydration and hypernatremia if not balanced with hypotonic IV solution.D₅W and 0.45 NS are hypotonic solutions.A client with hypertonic feedings who can drink liquids should have enough oral fluid intake to prevent dehydration and hypernatremia.The client receiving both a hypertonic enteral feeding and an isotonic IV solution would be at highest risk.

Question 8

The nurse is caring for a client who was started on total parenteral nutrition (TPN)2 days previously.The client reports blurred vision,dry mouth,and frequent urination.Which is the nurse's priority action?

Accepted Answer

Dry mouth,frequent urination,and blurred vision all are symptoms of hyperglycemia,a potential complication of TPN infusion.The nurse should assess the client's blood sugar level.Weighing the client and checking vital signs will not help with assessment of hyperglycemia.The nurse should obtain an order from the provider to slow the TPN solution.

Question 9

A facility is beginning to perform bariatric surgery on obese clients.Which action by the nursing manager is most important?

Accepted Answer

All actions might be appropriate and helpful in the care of bariatric clients.However,staff and client safety is a unique priority when working with this group of clients.The manager must ensure appropriately sized equipment,so that neither staff nor clients injure themselves.

Question 10

A client who is malnourished has a total lymphocyte count of 1450/mm³.Which instruction does the nurse provide to the unlicensed assistive personnel helping to care for this client?

Accepted Answer

Clients who are malnourished often have a low total lymphocyte count,which puts them at higher risk for infection.The nurse should emphasize good hand hygiene.The other interventions may be appropriate depending on client needs,but good hand hygiene would be the priority.

Question 11

A client has a small-bore nasoenteric feeding tube.The nurse assesses the following vital signs: temperature,100.2° F (37.8° C); pulse,112 beats/min; respiratory rate,22 breaths/min; and blood pressure,106/62 mm Hg.Which action by the nurse takes priority?

Accepted Answer

The client may have aspirated.The nurse should further assess the client's respiratory and oxygenation status.The client may have another reason for the abnormal vital signs,so the nurse should not pull out the tube before performing other assessments.Adding blue dye to the tube feeding formula is not recommended to check for aspiration.Slowing the feeding down will not be helpful.

Question 12

A severely malnourished client was started on enteral feedings.The following day,the client is confused,has a heart rate of 112 beats/min,and reports feeling weak.Which laboratory value does the nurse correlate with this condition?

Accepted Answer

This client has refeeding syndrome,which is caused primarily by hypophosphatemia.The serum phosphate level is low.The potassium is slightly low,but this is not related.The sodium is normal,and the glucose is not related.

Question 13

The nurse is caring for a client who has a new small-bore nasoduodenal tube for feedings.Which intervention most effectively prevents clogging of the tube?

Accepted Answer

Irrigating the feeding tube with 20 to 30 mL of warm water before and after medication administration will help maintain patency of the tube.Irrigation with cranberry juice or carbonated beverages is not recommended.Administration of only liquid medications (not crushed and dissolved in liquid)through the tube will help prevent clogging.Dilution of tube feeding should not be done without an order from the provider.

Question 14

Which statement indicates that the client needs additional discharge teaching after gastric bypass surgery?

Accepted Answer

After gastric bypass surgery,clients are limited to fluids and pureed foods for about 6 weeks.Then the client can progress to a more normal diet.Eating fruit right after discharge would not be recommended.The other statements indicate good understanding.

Question 15

The postanesthesia care nurse is caring for a client who had gastric banding surgery and was extubated an hour ago.The client's blood gases are as follows: pH,7.22; HCO₃^- 21 mEq/L; PCO₂,65 mm Hg; and PO₂,58 mm Hg.Which is the priority action by the nurse?

Accepted Answer

Obese clients are at higher risk for hypoventilation.The arterial blood gas values indicate acute respiratory acidosis with hypoxia.The client needs oxygen.However,if the airway is not patent,increasing the oxygen flow rate will be of minimal benefit.The first action is to ensure a patent airway and then apply oxygen,notify the physician,and document events.The client may need to be re-intubated and mechanically ventilated.Checking the client's oxygen saturation level will provide no additional information about the client's oxygenation status.

Question 16

The nurse is preparing to administer tube feedings through a client's new Salem sump nasogastric tube.The nurse is unable to withdraw any fluid from the tube before starting the feeding.Which is the priority action of the nurse?

Accepted Answer

The nurse must verify tube placement before beginning any tube feeding or administering any medications through a tube.The most accurate way to determine placement is via chest x-ray.The nurse could cause the client to aspirate if she or he started the feeding then checked later for placement.Insufflation does not provide accurate results and should not be used to verify tube placement.The nurse must keep the client's head elevated at least 30 degrees.

Question 17

The nurse is caring for an anorexic client who is severely malnourished.A nasogastric feeding tube is inserted,and tube feedings are started.Which laboratory finding is the best indication that the client's nutritional status is improving?

Accepted Answer

The prealbumin level is a good measure of nutritional status because its half-life is only 2 days,so it reflects current nutritional status.The client's prealbumin level is rising and almost normal,indicating that the client's nutritional status is improving.The other laboratory values are more reflective of fluid balance and kidney function.

Question 18

The nurse is reviewing recent laboratory values for a client who is being treated for malnutrition.Which laboratory finding indicates that the client is not receiving adequate iron supplementation?

Accepted Answer

Hematocrit is an indicator of iron status.Low hematocrit may indicate that the client has not received enough iron supplementation and remains anemic.Serum albumin indicates protein intake and CPK is a measure of muscle injury.An elevated ESR indicates inflammation.

Question 19

The nurse is caring for a male client who is 6 feet,1 inch tall and weighs 215 pounds.The client asks the nurse if his weight is appropriate for his height.Which is the nurse's best response?

Accepted Answer

The client's BMI is 28.4,indicating that the client is overweight.However,he is not obese.The nurse should not state that the client's weight is just about right,a few pounds under,or quite a bit over the ideal weight for his height.

Question 20

The new nursing supervisor at a long-term care facility is concerned about the number of residents who appear malnourished.Which action by the nurse is best?

Accepted Answer

All actions would be helpful.However,because unrecognized dysphagia is common among older clients,the nurse should first assess for this.Weighing residents,providing snacks,and assessing their opinions on the quality of food will not be helpful if at-risk residents cannot swallow.

Quiz 63: Care of Patients With Malnutrition and Obesity

The nurse is caring for an obese client who will be taking orlistat (Xenical) to help her lose weight.Which statement indicates that the client understands teaching about orlistat?

The nurse is caring for a client who is a vegan and has developed B₁₂ deficiency.Which foods does the nurse encourage the client to include in the diet?

The nurse is caring for a female client who is 5 feet,7 inches tall and weighs 115 pounds.The client asks the nurse if she needs to lose weight.Which response by the nurse is best?

Which dietary adjustments does the nurse recommend to an older adult client asking what changes she should institute to prevent or manage constipation?

The nurse is caring for a client on a limited income who has been diagnosed with kwashiorkor.Which foods does the nurse suggest to improve the client's nutritional status with minimal increase in food costs?

The nurse is caring for an overweight client who gained 10 pounds during the previous 2 weeks.The client states that she is hungry all the time and doesn't understand why.Which assessment finding could explain the client's weight gain and hunger?

Which client is at highest risk for developing dehydration and hypernatremia as a result of enteral feedings?

The nurse is caring for a client who was started on total parenteral nutrition (TPN) 2 days previously.The client reports blurred vision,dry mouth,and frequent urination.Which is the nurse's priority action?

A facility is beginning to perform bariatric surgery on obese clients.Which action by the nursing manager is most important?

A client who is malnourished has a total lymphocyte count of 1450/mm³.Which instruction does the nurse provide to the unlicensed assistive personnel helping to care for this client?

A client has a small-bore nasoenteric feeding tube.The nurse assesses the following vital signs: temperature,100.2° F (37.8° C) ; pulse,112 beats/min; respiratory rate,22 breaths/min; and blood pressure,106/62 mm Hg.Which action by the nurse takes priority?

A severely malnourished client was started on enteral feedings.The following day,the client is confused,has a heart rate of 112 beats/min,and reports feeling weak.Which laboratory value does the nurse correlate with this condition?

The nurse is caring for a client who has a new small-bore nasoduodenal tube for feedings.Which intervention most effectively prevents clogging of the tube?

Which statement indicates that the client needs additional discharge teaching after gastric bypass surgery?

The postanesthesia care nurse is caring for a client who had gastric banding surgery and was extubated an hour ago.The client's blood gases are as follows: pH,7.22; HCO₃^- 21 mEq/L; PCO₂,65 mm Hg; and PO₂,58 mm Hg.Which is the priority action by the nurse?

The nurse is preparing to administer tube feedings through a client's new Salem sump nasogastric tube.The nurse is unable to withdraw any fluid from the tube before starting the feeding.Which is the priority action of the nurse?

The nurse is caring for an anorexic client who is severely malnourished.A nasogastric feeding tube is inserted,and tube feedings are started.Which laboratory finding is the best indication that the client's nutritional status is improving?

The nurse is reviewing recent laboratory values for a client who is being treated for malnutrition.Which laboratory finding indicates that the client is not receiving adequate iron supplementation?

The nurse is caring for a male client who is 6 feet,1 inch tall and weighs 215 pounds.The client asks the nurse if his weight is appropriate for his height.Which is the nurse's best response?

The new nursing supervisor at a long-term care facility is concerned about the number of residents who appear malnourished.Which action by the nurse is best?

Quiz 63: Care of Patients With Malnutrition and Obesity

The nurse is caring for an obese client who will be taking orlistat (Xenical) to help her lose weight.Which statement indicates that the client understands teaching about orlistat?

The nurse is caring for a client who is a vegan and has developed B12 deficiency.Which foods does the nurse encourage the client to include in the diet?

The nurse is caring for a female client who is 5 feet,7 inches tall and weighs 115 pounds.The client asks the nurse if she needs to lose weight.Which response by the nurse is best?

Which dietary adjustments does the nurse recommend to an older adult client asking what changes she should institute to prevent or manage constipation?

The nurse is caring for a client on a limited income who has been diagnosed with kwashiorkor.Which foods does the nurse suggest to improve the client's nutritional status with minimal increase in food costs?

The nurse is caring for an overweight client who gained 10 pounds during the previous 2 weeks.The client states that she is hungry all the time and doesn't understand why.Which assessment finding could explain the client's weight gain and hunger?

Which client is at highest risk for developing dehydration and hypernatremia as a result of enteral feedings?

The nurse is caring for a client who was started on total parenteral nutrition (TPN) 2 days previously.The client reports blurred vision,dry mouth,and frequent urination.Which is the nurse's priority action?

A facility is beginning to perform bariatric surgery on obese clients.Which action by the nursing manager is most important?

A client who is malnourished has a total lymphocyte count of 1450/mm3.Which instruction does the nurse provide to the unlicensed assistive personnel helping to care for this client?

A client has a small-bore nasoenteric feeding tube.The nurse assesses the following vital signs: temperature,100.2° F (37.8° C) ; pulse,112 beats/min; respiratory rate,22 breaths/min; and blood pressure,106/62 mm Hg.Which action by the nurse takes priority?

A severely malnourished client was started on enteral feedings.The following day,the client is confused,has a heart rate of 112 beats/min,and reports feeling weak.Which laboratory value does the nurse correlate with this condition?

The nurse is caring for a client who has a new small-bore nasoduodenal tube for feedings.Which intervention most effectively prevents clogging of the tube?

Which statement indicates that the client needs additional discharge teaching after gastric bypass surgery?

The postanesthesia care nurse is caring for a client who had gastric banding surgery and was extubated an hour ago.The client's blood gases are as follows: pH,7.22; HCO3- 21 mEq/L; PCO2,65 mm Hg; and PO2,58 mm Hg.Which is the priority action by the nurse?

The nurse is preparing to administer tube feedings through a client's new Salem sump nasogastric tube.The nurse is unable to withdraw any fluid from the tube before starting the feeding.Which is the priority action of the nurse?

The nurse is caring for an anorexic client who is severely malnourished.A nasogastric feeding tube is inserted,and tube feedings are started.Which laboratory finding is the best indication that the client's nutritional status is improving?

The nurse is reviewing recent laboratory values for a client who is being treated for malnutrition.Which laboratory finding indicates that the client is not receiving adequate iron supplementation?

The nurse is caring for a male client who is 6 feet,1 inch tall and weighs 215 pounds.The client asks the nurse if his weight is appropriate for his height.Which is the nurse's best response?

The new nursing supervisor at a long-term care facility is concerned about the number of residents who appear malnourished.Which action by the nurse is best?

The nurse is caring for a client who is a vegan and has developed B₁₂ deficiency.Which foods does the nurse encourage the client to include in the diet?

A client who is malnourished has a total lymphocyte count of 1450/mm³.Which instruction does the nurse provide to the unlicensed assistive personnel helping to care for this client?

The postanesthesia care nurse is caring for a client who had gastric banding surgery and was extubated an hour ago.The client's blood gases are as follows: pH,7.22; HCO₃^- 21 mEq/L; PCO₂,65 mm Hg; and PO₂,58 mm Hg.Which is the priority action by the nurse?