Nokea
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.
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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.
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.
The nurse is caring for a patient who is receiving continuous enteral nutrition through a small-bore silicone feeding tube, has a computed tomography (CT) scan ordered, and will have to be placed in a flat position for the scan. Which of the following actions by the nurse is best?
- A. Shut the feeding off 30-60 minutes before the scan.
- B. Ask the health care provider to reschedule the CT scan.
- C. Connect the feeding tube to continuous suction during the scan.
- D. Send the patient to CT scan with oral suction in case of aspiration.
Correct Answer: A
Rationale: The tube feeding should be shut off 30-60 minutes before any procedure requiring the patient to lie flat. Because the CT scan is ordered for diagnosis of patient problems, rescheduling is not usually an option. Prevention, rather than treatment, of aspiration is needed. Small-bore feeding tubes are soft and collapse easily with aspiration or suction, making nasogastric suction of gastric contents unreliable.
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 nurse is caring for a patient with anorexia nervosa who is 163 cm tall and weighs 41 kg. Laboratory tests reveal hypokalemia and iron-deficiency anemia. Which of the following nursing diagnoses has the highest priority for the patient?
- A. Risk for activity intolerance as evidenced by physical deconditioning
- B. Risk for electrolyte imbalance as evidenced by insufficient fluid volume
- C. Ineffective health maintenance related to ineffective coping strategies (obsession with body image).
- D. Imbalanced nutrition: less than body requirements related to insufficient dietary intake
Correct Answer: B
Rationale: The patient's hypokalemia may lead to life-threatening cardiac dysrhythmias. The other diagnoses also are appropriate for this patient but are not associated with immediate risk for fatal complications.