Nokea
How many grams of protein will the nurse recommend to meet the minimum daily requirement for a patient who weighs 66 kg?
- A. 36
- B. 53
- C. 75
- D. 98
Correct Answer: B
Rationale: The recommended daily protein intake is 0.8-1 g/kg of body weight, which for this patient is 66 kg x 0.8 g = 52.8 or 53 g/day.
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The nurse is caring for a patient with a body mass index (BMI) of 31 kg/m?², a normal C-reactive protein level, and low transferrin and albumin levels. The nurse will plan patient teaching to increase the patient's intake of foods that are high in which of the following?
- A. Iron
- B. Protein
- C. Calories
- D. Carbohydrate
Correct Answer: B
Rationale: The patient's C-reactive protein and transferrin levels indicate low protein stores. The BMI is in the obese range, so increasing caloric intake is not indicated. The data do not indicate a need for increased carbohydrate or iron intake.
The nurse receives change-of-shift report about the following four patients. Which of the following patients should the nurse assess first?
- A. A patient who has malnutrition associated with 4+ generalized pitting edema
- B. A patient whose parenteral nutrition has 10 mL of solution left in the infusion bag
- C. A patient whose gastrostomy tube is plugged after crushed medications were given through the tube
- D. A patient who is receiving continuous enteral feedings and has new-onset crackles throughout the lungs
Correct Answer: D
Rationale: The patient data suggest aspiration has occurred and rapid assessment and intervention are needed. The other patients also should be assessed as quickly as possible, but the data about them do not suggest any immediately life-threatening complications.
The nurse is caring for a patient with protein calorie malnutrition who has had abdominal surgery and is receiving parenteral nutrition (PN). Which of the following findings is the best indicator that the patient is receiving adequate nutrition?
- A. Blood glucose is 6.1 mmol/L.
- B. Serum albumin level is 35 g/L.
- C. Fluid intake and output are balanced.
- D. Surgical incision is healing normally.
Correct Answer: D
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 in the low-normal range but does not reflect adequate caloric intake, which is also important for the patient.
The nurse has just started a patient on continuous tube feedings of a full-strength commercial formula at 100 mL/hour using a closed system method and has had six diarrhea stools the first day. Which of the following actions should the nurse plan to take?
- A. Slow the infusion rate of the tube feeding.
- B. Check gastric residual volumes more frequently.
- C. Change the enteral feeding system and formula every 8 hours.
- D. Discontinue administration of water through the feeding tube.
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 should be given when patients receive enteral feedings to prevent dehydration. When a closed enteral feeding system is used, the tubing and formula are changed every 24 hours. High residual volumes do not contribute to diarrhea.
After 6 hours of parenteral nutrition (PN) infusion, the nurse checks a patient's capillary blood glucose level and finds it to be 6.7 mmol/L. Which of the following actions should the nurse take?
- A. Obtain a venous blood glucose specimen.
- B. Slow the infusion rate of the PN infusion.
- C. Recheck the capillary blood glucose in 4 hours.
- D. Notify the health care provider of the glucose level.
Correct Answer: C
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, notification of the health care provider is not necessary. 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.