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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.
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The nurse is admitting a patient for electrolyte disorders of unknown etiology. Which of the following findings is most important to report to the health care provider?
- A. The patient's knuckles are macerated.
- B. The patient uses laxatives on a daily basis.
- C. The patient has a history of weight fluctuations.
- D. The patient's serum potassium level is 2.2 mmol/L.
Correct Answer: D
Rationale: The low serum potassium level may cause life-threatening cardiac dysrhythmias and potassium supplementation is needed rapidly. The other information also will be reported because it suggests that bulimia may be the etiology of the patient's electrolyte disturbances, but it does not suggest imminent life-threatening complications.
The nurse is caring for a comatose patient who is receiving continuous enteral nutrition through a soft nasogastric tube and notes the presence of new crackles in the patient's lungs. In which order will the nurse take the following actions?
- A. Turn off the tube feeding.
- B. Document assessment findings.
- C. Check the tube feeding residual volume.
- D. Notify the patient's health care provider.
Correct Answer: A,C,D,B
Rationale: The assessment data indicate that aspiration may have occurred, and the nurse's first action should be to turn off the tube feeding to avoid further aspiration. The next action should be to check the residual volume because it provides data about possible causes of aspiration. The health care provider should be notified and informed of all the assessment data the nurse has just obtained. Lastly, the nurse documents the assessment findings.
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.
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.
The nurse is teaching a patient about a high calorie, high protein diet. Which of the following menu choices indicates that the teaching has been effective?
- A. Baked fish with applesauce
- B. Beef noodle soup and canned corn
- C. Fresh vegetables with yogurt topping
- D. Fried chicken with potatoes and gravy
Correct Answer: D
Rationale: Foods that are high in calories include fried foods and those covered with sauces. High protein foods include meat and dairy products. The other choices are lower in calories and protein.