Nokea
The nurse is caring for a patient and notes that the peripheral parenteral nutrition (PN) bag has only 20 mL left and a new PN bag has not yet arrived from the pharmacy. Which of the following interventions is priority?
- A. Monitor the patient's capillary blood glucose until a new PN bag is hung.
- B. Flush the peripheral line with saline and wait until the new PN bag is available.
- C. Infuse 5% dextrose in water until the new PN bag is delivered from the pharmacy.
- D. Decrease the rate of the current PN infusion to 10 mL/hour until the new bag arrives.
Correct Answer: C
Rationale: To prevent hypoglycemia, the nurse should infuse a 5% dextrose solution until the next PN bag can be started. Decreasing the rate of the ordered PN infusion is beyond the nurse's scope of practice. Flushing the line and then waiting for the next bag may lead to hypoglycemia. Monitoring the capillary blood glucose is appropriate but is not the priority.
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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.
During a busy day, the nurse admits all of the following patients to the medical-surgical unit. Which patients are most important to refer to the dietitian for a complete nutritional assessment?
- A. A 24-year-old who has a history of weight gains and losses
- B. A 53-year-old who complains of intermittent nausea for the past 2 days
- C. A 66-year-old who is admitted for debridement of an infected surgical wound
- D. A 45-year-old admitted with chest pain and possible myocardial infarction (MI)
- E. A 32-year-old with rheumatoid arthritis who takes prednisone daily
Correct Answer: A,C,E
Rationale: Weight fluctuations, use of corticosteroids, and draining or infected wounds all suggest that the patient may be at risk for malnutrition. Patients with chest pain or MI are not usually poorly nourished. Although vomiting that lasts 5 days places a patient at risk, nausea that has persisted for 2 days does not always indicate poor nutritional status or risk for health problems caused by poor nutrition.
The nurse is caring for a patient who is receiving tube feedings through a percutaneous endoscopic gastrostomy (PEG). Which of the following actions should the nurse include in the plan of care?
- A. Keep the patient positioned on the left side.
- B. Obtain a daily x-ray to verify tube placement.
- C. Check the gastric residual volume every 4-6 hours.
- D. Avoid giving bolus tube feedings through the PEG tube.
Correct Answer: C
Rationale: The gastric residual volume is assessed every 4-6 hours to decrease the risk for aspiration. The patient does not need to be positioned on the left side. An x-ray is obtained immediately after placement of the PEG tube to check position, but daily x-rays are not needed. Bolus feedings can be administered through a PEG tube.
Which of the following actions should the nurse implement when using a soft, silicone nasogastric tube for enteral feedings?
- A. Avoid giving medications through the feeding tube.
- B. Flush the tubing after checking for residual volumes.
- C. Administer continuous feedings using an infusion pump.
- D. Replace the tube every 3-5 days to avoid mucosal damage.
Correct Answer: B
Rationale: The soft silicone feeding tubes are small in diameter and can easily become clogged unless they are flushed after the nurse checks the residual volume. Either intermittent or continuous feedings can be given. The tubes are less likely to cause mucosal damage than the stiffer polyvinyl chloride tubes used for nasogastric suction and do not need to be replaced at certain intervals. Medications can be given through these tubes, but flushing after medication administration is important to avoid clogging.
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.