Nokea
The nurse is assessing a patient who is a vegan. Which of the following findings may indicate the need for cobalamin supplementation?
- A. Anemia
- B. Ecchymoses
- C. Dry, scaly skin
- D. Gingival swelling
Correct Answer: A
Rationale: Cobalamin (vitamin B12) cannot be obtained from foods of plant origin, so the patient will be most at risk for signs of cobalamin deficiency, megaloblastic anemia, and the neurological signs of cobalamin deficiency. The other symptoms listed are associated with other nutritional deficiencies but would not be associated with a vegan diet.
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The nurse is caring for a patient who is to have a bolus tube feeding. Which of the following actions should the nurse implement?
- A. Deliver the feeding via a syringe over 15 minutes.
- B. Increase the rate of the tube feeding to deliver the bolus over 5 minutes.
- C. Withhold water by mouth for 30 minutes prior to the bolus feeding.
- D. Question the order as tube feedings are not to be delivered as a bolus.
Correct Answer: A
Rationale: Bolus feedings are typically delivered by gravity via a syringe over approximately 15 minutes when the feeding tube is placed in the stomach. The tube feeding rate would not be increased as the bolus should be delivered by gravity via a syringe. It's important to remember that the patient still needs water (1 mL/cal formula received), and this may be administered at any time that the patient can tolerate it.
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.
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.
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.
The student nurse is caring for a patient who is receiving intermittent tube feedings. Which of the following actions by the student nurse should cause the RN to intervene in the patient's care?
- A. Positions the head of the bed at 30 degrees.
- B. Flushes the tube before and after the feeding.
- C. Checks residual volume every hour.
- D. Maintains the elevated bed position one hour after the feeding.
Correct Answer: C
Rationale: The residual volume should be checked every 4 hours, not every hour. Elevating the head of the bed to a minimum of 30 degrees, but preferably 45 degrees, prevents aspiration. With intermittent delivery, the head should remain elevated for 30-60 minutes after feeding. The tube is to be flushed before and after the feeding.