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The nurse is caring for a patient who is malnourished and is receiving parenteral nutrition (PN) containing amino acids and dextrose for the past 24 hours. The nurse observes that about 50 mL remain in the PN container. Which of the following actions is best for the nurse to take?
- A. Ask the health care provider to clarify the written PN order.
- B. Add a new container of PN using the current tubing and filter.
- C. Hang a new container of PN and change the IV tubing and filter.
- D. Infuse the remaining 50 mL and then hang a new container of PN.
Correct Answer: B
Rationale: All PN solutions are changed at 24 hours. PN solutions containing dextrose and amino acids require a change in tubing and filter every 72 hours rather than daily. Infusion of the additional 50 mL will increase patient risk for infection. Changing the IV tubing and filter more frequently than required will unnecessarily increase costs. The nurse (not the health care provider) is responsible for knowing the indicated times for tubing and filter changes.
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The nurse is caring for a patient who has a wound infection after major surgery and has only been taking in about 50% to 75% of the ordered meals. The patient states, 'Nothing on the menu really appeals to me.' Which of the following actions by the nurse will be most effective in improving the patient's oral intake?
- A. Make a referral to the dietitian.
- B. Order at least six small meals daily.
- C. Teach the patient about high-calorie, high-protein foods.
- D. Have family members bring in favourite foods from home.
Correct Answer: D
Rationale: The patient's statement that the hospital foods are unappealing indicates that favourite home-cooked foods might improve intake. The other interventions also may help improve the patient's intake, but the most effective action will be to offer the patient more appealing foods.
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.
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.
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.
Which of the following actions should the nurse take first in order to improve calorie and protein intake for a patient who eats only about 50% of each meal because of 'feeling too tired to eat much'?
- A. Teach the patient about the importance of good nutrition
- B. Serve multiple small feedings of high-calorie, high-protein foods.
- C. Obtain an order for enteral feedings of liquid nutritional supplements.
- D. Consult with the health care provider about providing parenteral nutrition (PN).
Correct Answer: B
Rationale: Eating small amounts of food frequently throughout the day is less fatiguing and will improve the patient's ability to take in more nutrients. Teaching the patient may be appropriate, but will not address the patient's inability to eat more because of fatigue. Tube feedings or PN may be needed if the patient is unable to take in enough nutrients orally, but increasing the oral intake should be attempted first.