enteral and parenteral nutrition
A nurse is assessing a client receiving total parenteral nutrition (TPN). Which finding is most concerning?
A. Capillary blood glucose of 190 mg/dL
B. Weight gain of 2 lbs over three days
C. Temperature of 101.2°F (38.4°C)
D. Mild nausea and bloating
Correct Answer: C. Temperature of 101.2°F (38.4°C)
Rationale:
A fever in a client with TPN raises concern for central line-associated bloodstream infection (CLABSI), a serious complication. Hyperglycemia (glucose 190 mg/dL) is expected and managed with insulin. Mild nausea and weight gain are common but not urgent concerns.
Which of the following clients is at highest risk for malnutrition?
A. A 45-year-old client with a BMI of 28 who eats a vegetarian diet
B. A 67-year-old client with advanced Parkinson’s disease and difficulty swallowing
C. A 32-year-old postpartum client who is breastfeeding
D. A 25-year-old athlete with a high-protein diet
Correct Answer: B. A 67-year-old client with advanced Parkinson’s disease and difficulty swallowing
Rationale:
Clients with neurological disorders (e.g., Parkinson’s disease) often experience dysphagia, which increases the risk of aspiration and inadequate intake, leading to malnutrition
Which of the following is the most accurate recommendation for protein intake in a critically ill patient with multiple trauma and burns?
A. 1-1.2 g/kg body weight
B. 1.2-2.0 g/kg body weight
C. 2.0-2.5 g/kg body weight
D. 2.5-3.0 g/kg body weight
Correct Answer: C. 2.0-2.5 g/kg body weight
Rationale:
Critically ill patients, especially those with burns or trauma, have significantly increased protein needs for tissue repair and immune function. The recommended protein intake for these patients is 2.0-2.5 g/kg body weight per day. Protein is essential to maintain lean muscle mass, support immune function, and promote wound healing.
A client with peptic ulcer disease (PUD) asks the nurse what foods should be avoided to reduce symptoms. Which of the following foods should the nurse advise the patient to limit or avoid?
A. Whole-grain cereals
B. Lean meats
C. Caffeinated beverages
D. Nonfat dairy products
Correct Answer: C. Caffeinated beverages
Rationale:
Caffeine stimulates gastric acid secretion, which can irritate the ulcer and exacerbate symptoms. Patients with PUD should avoid caffeine, alcohol, and spicy foods to help reduce irritation of the gastric mucosa.
A nurse is caring for a patient with Crohn's disease. What dietary modification should the nurse prioritize to help manage the patient’s symptoms?
A. Encourage high-fiber foods to promote bowel function.
B. Limit high-fat foods to reduce inflammation.
C. Increase dairy products to prevent calcium deficiency.
D. Offer low-residue foods to reduce irritation.
Correct Answer: D. Offer low-residue foods to reduce irritation.
Rationale:
For patients with Crohn's disease, low-residue foods (which are low in fiber) are often recommended to reduce irritation of the intestinal lining. A high-fiber diet may exacerbate symptoms by increasing bowel motility and irritation. Dairy products should be limited in case of lactose intolerance, a common issue in Crohn's disease.
A client who has been receiving TPN for two weeks is now tolerating small amounts of clear liquids. Which action should the nurse take?
A. Discontinue TPN immediately and encourage oral intake
B. Decrease TPN rate while increasing oral intake
C. Switch the client to enteral tube feedings before stopping TPN
D. Keep the client NPO for 24 hours before stopping TPN
Correct Answer: B. Decrease TPN rate while increasing oral intake
Rationale:
TPN should be gradually decreased while oral intake is introduced to prevent hypoglycemia and allow the GI tract to adjust. Enteral feedings are not necessary if the client can tolerate oral intake. Keeping the client NPO is not appropriate in this transition phase.
Which assessment finding is most concerning for malnutrition?
A. BMI of 26 and increased appetite
B. Unintentional weight loss of 10% over 6 months
C. Reports of eating three balanced meals daily
D. Mild anemia but stable weight
Correct Answer: B. Unintentional weight loss of 10% over 6 months
Rationale:
Unintentional weight loss of more than 5% in one month or 10% in six months is a red flag for malnutrition. Even if a client’s BMI is in the normal range, significant weight loss indicates inadequate nutrient intake.
A nurse is caring for a client in severe metabolic stress due to sepsis. Which of the following is the most appropriate source of energy for this client?
A. High-protein, low-carbohydrate diet
B. High-carbohydrate, low-fat diet
C. Moderate-protein, moderate-carbohydrate diet
D. High-fat, low-protein diet
Correct Answer: A. High-protein, low-carbohydrate diet
Rationale:
In metabolic stress, particularly in sepsis, the body has increased protein breakdown and catabolism. A high-protein, low-carbohydrate diet helps preserve lean muscle mass while avoiding the excess glucose that may contribute to hyperglycemia. A high-fat diet is less preferred due to the need for carbohydrates in energy metabolism
A client with gastroesophageal reflux disease (GERD) asks the nurse what foods to avoid to alleviate symptoms. Which of the following foods should be avoided by the patient?
A. Bananas
B. Tomato-based products
C. Lean chicken
D. Whole wheat bread
Correct Answer: B. Tomato-based products
Rationale:
Tomato-based products can irritate the esophagus and increase acid reflux in patients with GERD. It is also important for GERD patients to avoid citrus fruits, spicy foods, and chocolate to prevent exacerbating reflux symptoms.
A client with ulcerative colitis (UC) is experiencing a flare-up. What dietary recommendation should the nurse provide to help manage the client’s symptoms?
A. Consume frequent, small meals with a high-protein, high-calorie diet.
B. Increase fiber intake to promote bowel movement regularity.
C. Eat large meals that are low in fat to reduce digestive stress.
D. Eliminate all dairy products to prevent bloating.
Correct Answer: A. Consume frequent, small meals with a high-protein, high-calorie diet.
Rationale:
During a flare-up of ulcerative colitis, it is important to provide high-protein, high-calorie foods to prevent malnutrition and encourage frequent, small meals to avoid bowel overloading. A low-fiber diet is typically recommended during flare-ups, while dairy elimination is only needed if the patient has lactose intolerance.
A nurse is preparing to administer multiple medications via a nasogastric tube. Which action is most appropriate?
A. Crush all medications together and dissolve in one cup of water
B. Mix liquid and crushed medications before administration
C. Flush the tube with water before, between, and after each medication
D. Administer all medications at once to minimize fluid intake
Correct Answer: C. Flush the tube with water before, between, and after each medication
Rationale:
Flushing the tube before, between, and after medications helps prevent tube obstruction and medication interactions. Medications should be administered separately, and enteric-coated or extended-release drugs should not be crushed.
Which laboratory value is most commonly used to assess long-term malnutrition?
A. Serum albumin
B. Blood glucose
C. White blood cell count
D. Hemoglobin A1C
Correct Answer: A. Serum albumin
Rationale:
Serum albumin is an indicator of chronic protein status and helps identify long-term malnutrition. However, it can be affected by inflammation and fluid balance, so prealbumin levels may also be considered.
A nurse is preparing to administer enteral nutrition (EN) to a critically ill patient. What is the priority nursing intervention before starting the feedings?
A. Confirm tube placement
B. Check the client’s blood glucose level
C. Measure residuals before each feeding
D. Ensure the patient is NPO for 12 hours
Correct Answer: A. Confirm tube placement
Rationale:
Before administering enteral nutrition, the nurse must always verify the placement of the feeding tube to reduce the risk of aspiration or improper delivery of nutrients. Checking residuals and blood glucose are important during feedings but are not the priority before initiation.
A patient with a peptic ulcer caused by Helicobacter pylori infection asks if there are any specific dietary changes needed. What is the nurse’s most appropriate response?
A. “Consume dairy products as they help coat the ulcer and provide relief.”
B. “You should avoid caffeinated beverages, as they can increase acid production.”
C. “Eat frequent, large meals to keep your stomach full and prevent ulcers.”
D. “Take antacids between meals to help neutralize stomach acid.”
Correct Answer: B. You should avoid caffeinated beverages, as they can increase acid production.
Rationale:
Caffeine stimulates gastric acid secretion, which can worsen peptic ulcers, especially in the presence of H. pylori. Reducing caffeine intake helps manage symptoms and prevent further irritation of the ulcer.
A nurse is educating a patient diagnosed with celiac disease about their dietary restrictions. Which of the following foods should be avoided by the patient?
A. Whole wheat bread
B. Brown rice
C. Lean meats
D. Low-fat yogurt
Correct Answer: A. Whole wheat bread
Rationale:
Celiac disease is a condition where the body reacts to gluten, which is found in wheat, barley, and rye. Whole wheat bread should be avoided, and the patient should choose gluten-free alternatives. Foods such as brown rice, lean meats, and low-fat yogurt are gluten-free and safe for patients with celiac disease.
A client receiving intermittent bolus enteral feedings via a gastrostomy tube reports dizziness, sweating, and abdominal cramping shortly after the feeding. The nurse recognizes this as dumping syndrome. Which intervention is most appropriate?
A. Increase the feeding rate to help the client adjust
B. Change to a more concentrated formula
C. Lower the feeding rate and administer feedings at room temperature
D. Keep the client in a supine position for 30 minutes after feeding
Correct Answer: C. Lower the feeding rate and administer feedings at room temperature
Rationale:
Dumping syndrome occurs when feedings enter the small intestine too quickly, causing fluid shifts. Slowing the rate helps prevent symptoms. Cold feedings can worsen symptoms, and keeping the client supine increases aspiration risk.
Which client most likely requires parenteral nutrition (TPN) instead of enteral nutrition?
A. A client with dysphagia following a stroke
B. A client with severe Crohn’s disease and non-functioning intestines
C. A client with poor appetite and weight loss
D. A client who refuses to eat hospital food
Correct Answer: B. A client with severe Crohn’s disease and non-functioning intestines
Rationale:
Parenteral nutrition (TPN) is indicated when the GI tract is not functional (e.g., bowel obstruction, severe Crohn’s disease, short bowel syndrome). Enteral feeding is preferred whenever possible.
A nurse is caring for a patient with severe burns. Which of the following should the nurse expect to be prescribed for this patient’s nutritional therapy?
A. Hypercaloric and high-protein diet
B. Low-fat and high-carbohydrate diet
C. Low-calorie and low-protein diet
D. High-fat and low-sodium diet
Correct Answer: A. Hypercaloric and high-protein diet
Rationale:
Patients with severe burns have increased caloric and protein needs due to the hypermetabolic state. A hypercaloric and high-protein diet promotes wound healing, prevents muscle wasting, and supports the body’s increased energy demands.
A patient is diagnosed with dyspepsia and experiences bloating, indigestion, and nausea. What dietary intervention should the nurse recommend?
A. High-fat meals should be consumed to slow digestion.
B. Carbonated drinks should be avoided to prevent bloating.
C. Large meals should be consumed for optimal digestion.
D. High-protein, low-carb diets are recommended to help digestion.
Correct Answer: B. Carbonated drinks should be avoided to prevent bloating.
Rationale:
Carbonated drinks can cause bloating and worsen dyspepsia symptoms. For dyspepsia, it is important to avoid foods and drinks that cause gastric discomfort, including carbonated beverages, and opt for small, frequent meals that are easy to digest.
A client with lactose intolerance is asking which foods can be safely included in their diet. Which of the following should the nurse recommend?
A. Regular milk and cheese
B. Lactose-free milk and yogurt
C. Ice cream and cheese
D. Cottage cheese and buttermilk
Correct Answer: B. Lactose-free milk and yogurt
Rationale:
Patients with lactose intolerance have difficulty digesting lactose, the sugar found in dairy products. Lactose-free milk and yogurt (which may contain beneficial bacteria to aid digestion) are good alternatives. Regular milk, cheese, and ice cream are typically not tolerated due to their lactose content.
A client receiving total parenteral nutrition (TPN) reports excessive thirst and frequent urination. The nurse notes a blood glucose level of 245 mg/dL. What is the priority nursing intervention?
A. Slow the TPN infusion rate
B. Administer prescribed insulin and reassess
C. Stop the TPN infusion and notify the provider
D. Increase the client's oral fluid intake
Correct Answer: B. Administer prescribed insulin and reassess
Rationale:
Hyperglycemia is a common complication of TPN due to its high glucose content. The best intervention is to administer insulin as prescribed. Stopping or slowing TPN abruptly can cause hypoglycemia. Increasing oral fluids is not appropriate because TPN clients may have restricted oral intake.
A hospitalized client reports a poor appetite. Which intervention should the nurse implement first?
A. Provide nutritional supplements between meals
B. Encourage the client to eat only when they feel hungry
C. Offer high-calorie foods first during meals
D. Place a nasogastric tube for feeding
Correct Answer: C. Offer high-calorie foods first during meals
Rationale:
Clients with poor appetite should be encouraged to eat high-calorie, nutrient-dense foods first, before they become full. Supplements can also help but should not replace meals.
A malnourished client is started on parenteral nutrition (TPN). The nurse should be especially cautious of the risk for refeeding syndrome. Which is the most important nursing action to prevent this complication?
A. Slowly increase caloric intake over several days
B. Discontinue TPN immediately if symptoms of refeeding occur
C. Provide the client with a high fat diet
D. Start oral feeding immediately after the client tolerates TPN
Correct Answer: A. Slowly increase caloric intake over several days
Rationale:
Refeeding syndrome occurs when malnourished clients are reintroduced to nutrition too quickly. The gradual increase in caloric intake allows the body to adjust and avoid electrolyte imbalances, particularly hypophosphatemia.
A client who underwent gastric bypass surgery is recovering in the hospital. What is the first step in post-operative nutritional management?
A. Initiate clear liquids and gradually progress to solid foods.
B. Advise the client to eat three large meals per day.
C. Begin a high-calorie, high-fat diet to ensure adequate nutrition.
D. Start parenteral nutrition to avoid strain on the stomach.
Correct Answer: A. Initiate clear liquids and gradually progress to solid foods.
Rationale:
After gastric bypass surgery, the stomach is smaller, so the patient must gradually increase food intake, starting with clear liquids and progressing to soft foods and eventually solid foods. This approach helps prevent complications like dumping syndrome.
A client with diverticulosis is being discharged from the hospital. Which dietary recommendation should the nurse give to prevent further complications?
A. High-fiber diet to promote regular bowel movements
B. Low-fiber diet to reduce bowel irritability
C. Low-protein diet to prevent straining during defecation
D. Avoid fruits and vegetables to prevent diverticular rupture
Correct Answer: A. High-fiber diet to promote regular bowel movements
Rationale:
A high-fiber diet is recommended for patients with diverticulosis to promote regular bowel movements and reduce the risk of diverticular bleeding or infection (diverticulitis). Fiber softens stool and reduces the pressure in the colon, helping prevent exacerbation of the condition.