Nokea
Occult fecal blood may be an indication of:
- A. upper gastrointestinal bleeding
- B. lower gastrointestinal bleeding
- C. both
- D. neither
Correct Answer: C
Rationale: The correct answer is C: both. Occult fecal blood can indicate bleeding anywhere along the gastrointestinal tract. Upper gastrointestinal bleeding typically presents as melena (black, tarry stools), while lower gastrointestinal bleeding can manifest as occult blood in the stool. Therefore, occult fecal blood can be an indication of both upper and lower gastrointestinal bleeding. Choices A and B are incorrect because occult fecal blood is not exclusive to either upper or lower gastrointestinal bleeding alone. Choice D is incorrect since occult fecal blood can indeed be an indication of gastrointestinal bleeding.
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Which action for a patient receiving enteral nutrition through a percutaneous endoscopic gastrostomy (PEG) may be delegated to a licensed practical/vocational nurse (LPN/VN)?
- A. Assessing the patient's nutritional status weekly
- B. Providing skin care to the area around the tube site
- C. Teaching the patient how to administer the feedings
- D. Determining the need for adding water to the feedings
Correct Answer: B
Rationale: The correct answer is B: Providing skin care to the area around the tube site. This task can be safely delegated to an LPN/VN because it involves basic wound care and monitoring for signs of infection or skin breakdown. LPNs/VNs are trained to provide this type of care under the supervision of a registered nurse (RN).
A: Assessing the patient's nutritional status weekly requires a higher level of assessment and interpretation of data, which is typically within the scope of an RN.
C: Teaching the patient how to administer the feedings involves patient education and requires a higher level of critical thinking and assessment skills, typically performed by an RN.
D: Determining the need for adding water to the feedings involves making clinical judgments and adjustments to the enteral nutrition plan, which should be overseen by an RN.
Bile pigments:
- A. Are derived from globin portion of hemoglobin.
- B. Help in fat digestion and absorption.
- C. Are conjugated in the liver mainly with sulphate.
- D. Their level increases in blood in liver disease.
Correct Answer: D
Rationale: The correct answer is D because bile pigments, such as bilirubin, increase in the blood in liver disease due to impaired liver function. Bilirubin is a waste product from the breakdown of red blood cells and is normally processed by the liver. Elevated levels of bile pigments in the blood are a common indicator of liver dysfunction.
Choice A is incorrect because bile pigments are derived from heme, not the globin portion of hemoglobin.
Choice B is incorrect because bile pigments aid in the emulsification of fats but do not directly help in fat digestion and absorption.
Choice C is incorrect as bile pigments are conjugated with glucuronic acid, not sulphate, in the liver.
Which organ has the most metabolically active cells?
- A. pancreas
- B. liver
- C. stomach
- D. small intestine
Correct Answer: B
Rationale: The correct answer is B: liver. The liver has the most metabolically active cells due to its crucial role in various metabolic processes, such as detoxification, protein synthesis, and glucose metabolism. It is responsible for producing enzymes and metabolizing nutrients. The pancreas, stomach, and small intestine are important organs, but they are not as metabolically active as the liver. The pancreas primarily produces digestive enzymes and regulates blood sugar levels. The stomach digests food, and the small intestine absorbs nutrients. However, in terms of overall metabolic activity, the liver surpasses these organs.
The nurse is caring for a patient who has been experiencing severe diarrhea and can now resume solid foods. The nurse educates the patient about appropriate food choices. Which food choice indicates that the nurse's teaching has been successful?
- A. Whole-grain rice
- B. Wheat toast
- C. Applesauce
- D. Grapes
Correct Answer: C
Rationale: The correct answer is C: Applesauce. Applesauce is a low-fiber, easily digestible food that is gentle on the digestive system, making it an appropriate choice for someone recovering from severe diarrhea. It helps to bind stool and prevent further irritation. Whole-grain rice (choice A) and wheat toast (choice B) are high-fiber foods that may worsen diarrhea. Grapes (choice D) are high in natural sugars and can also aggravate diarrhea. In summary, the nurse's teaching is successful when the patient chooses applesauce because it is gentle on the digestive system and helps in recovery from diarrhea.
Which of the nurse's assigned patients should be referred to the dietitian for a complete nutritional assessment? (Select all that apply.)
- A. A 35-yr-old patient who reports intermittent nausea for the past 2 days
- B. A 48-yr-old patient with rheumatoid arthritis who takes prednisone daily
- C. A 23-yr-old patient who has a history of fluctuating weight gains and losses
- D. A 64-yr-old patient who is admitted for debridement of an infected surgical wound
Correct Answer: A
Rationale: The correct answer is A. This patient reporting intermittent nausea may have altered nutritional intake, which warrants a referral to the dietitian for a complete nutritional assessment. Nausea can affect food intake and nutrient absorption, potentially leading to malnutrition. Options B, C, and D do not directly indicate a need for a dietitian referral based on the information provided. The patient with rheumatoid arthritis taking prednisone may benefit from dietary interventions, but the information provided does not specify any nutritional concerns. The patient with fluctuating weight gains and losses may have nutritional issues, but further details are needed to justify a dietitian referral. The patient admitted for debridement of an infected wound may have increased nutritional needs due to wound healing, but this alone does not warrant a dietitian referral without additional information on the patient's nutritional status.