Medical-Surgical Nursing in Canada 4th Edition Lewi Test Bank
Chapter 42: Nursing Management: Nutritional Problems
Lewis: Medical-Surgical Nursing In Canada, 4th Canadian Edition
MULTIPLE CHOICE
1. The nurse is assessing a client 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
ANS: A
Cobalamin (vitamin B12) cannot be obtained from foods of plant origin, so the client 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.
DIF: Cognitive Level: Application
MSC: NCLEX: Physiological Integrity
TOP: Nursing Process: Assessment
2. The nurse is admitting a client with a body mass index (BMI) of 17 kg/m2 and a low albumin
level. Which of the following assessment findings should the nurse expect to find?
a. Restlessness
b. Hypertension
c. Pitting edema
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d. Food allergies
ANS: C
Edema occurs when serum albumin levels and plasma oncotic pressure decrease. The blood
pressure and level of consciousness are not directly affected by malnutrition. Food allergies
are not an indicator of nutritional status.
DIF: Cognitive Level: Application
MSC: NCLEX: Physiological Integrity
TOP: Nursing Process: Assessment
3. The nurse is teaching a client 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 yogourt topping
d. Fried chicken with potatoes and gravy
ANS: D
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.
DIF: Cognitive Level: Application
MSC: NCLEX: Physiological Integrity
TOP: Nursing Process: Evaluation
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4. The nurse is caring for a client with a body mass index (BMI) of 31 kg/m2, a normal
C-reactive protein level, and low transferrin and albumin levels. The nurse will plan client
teaching to increase the client’s intake of foods that are high in which of the following?
a. Iron
b. Protein
c. Calories
d. Carbohydrate
ANS: B
The client’s C-reactive protein and transferrin levels indicate low protein stores. The BMI is
in the obese range, so increasing caloric intake is not indicated. The data do not indicate a
need for increased carbohydrate or iron intake.
DIF: Cognitive Level: Application
MSC: NCLEX: Physiological Integrity
TOP: Nursing Process: Planning
5. The nurse has just started a client on continuous tube feedings of a full-strength commercial
formula at 100 mL/hour using a closed system method and has had six diarrhea stools the first
day. Which of the following actions should the nurse plan to take?
a. Slow the infusion rate of the tube feeding.
b. Check gastric residual volumes more frequently.
c. Change the enteral feeding system and formula every 8 hours.
d. Discontinue administration of water through the feeding tube.
ANS: A
Loose stools indicate poor absorption of nutrients and indicate a need to slow the feeding rate
or decrease the concentration of the feeding. Water should be given when clients receive
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enteral feedings to prevent dehydration.
a closed
TB.C
OM enteral feeding system is used, the
tubing and formula are changed every 24 hours. High residual volumes do not contribute to
diarrhea.
DIF: Cognitive Level: Application
MSC: NCLEX: Physiological Integrity
TOP: Nursing Process: Planning
6. The nurse is caring for a client 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 client 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.
ANS: C
The gastric residual volume is assessed every 4–6 hours to decrease the risk for aspiration.
The client 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.
DIF: Cognitive Level: Application
MSC: NCLEX: Physiological Integrity
TOP: Nursing Process: Planning
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Medical-Surgical Nursing in Canada 4th Edition Lewi Test Bank
7. The nurse is caring for a client 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.
ANS: B
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 client 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.
DIF: Cognitive Level: Application
MSC: NCLEX: Physiological Integrity
TOP: Nursing Process: Implementation
8. After 6 hours of parenteral nutrition (PN) infusion, the nurse checks a client’s capillary blood
glucose level and finds it to be 6.7 mmol/L. Which of the following actions should the nurse
take?
a. Obtain a venous blood glucose specimen.
b. Slow the infusion rate of the PN infusion.
c. Recheck the capillary blood glucose in 4 hours.
d. Notify the health care provider of the glucose level.
ANS: C
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B.Cfew
Mild hyperglycemia is expected
theTfirst
SING
OMdays after PN is started and requires
ongoing monitoring. Because the glucose elevation is small and expected, notification of the
health care provider is not necessary. There is no need to obtain a venous specimen for
comparison. Slowing the rate of the infusion is beyond the nurse’s scope of practice and will
decrease the client’s nutritional intake.
DIF: Cognitive Level: Application
MSC: NCLEX: Physiological Integrity
TOP: Nursing Process: Implementation
9. The nurse is caring for a client 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 client 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.
ANS: D
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Because poor wound healing is a possible complication of malnutrition for this client, 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 client’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 client.
DIF: Cognitive Level: Application
MSC: NCLEX: Physiological Integrity
TOP: Nursing Process: Evaluation
10. The nurse is caring for a client who has a wound infection after major surgery and has only
been taking in about 50% to 75% of the ordered meals. The client states, “Nothing on the
menu really appeals to me.” Which of the following actions by the nurse will be most
effective in improving the client’s oral intake?
a. Make a referral to the dietitian.
b. Order at least six small meals daily.
c. Teach the client about high-calorie, high-protein foods.
d. Have family members bring in favourite foods from home.
ANS: D
The client’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
client’s intake, but the most effective action will be to offer the client more appealing foods.
DIF: Cognitive Level: Application
MSC: NCLEX: Physiological Integrity
TOP: Nursing Process: Implementation
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11. 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.
ANS: B
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.
DIF: Cognitive Level: Application
MSC: NCLEX: Physiological Integrity
TOP: Nursing Process: Implementation
12. The nurse is caring for a client 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.
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Medical-Surgical Nursing in Canada 4th Edition Lewi Test Bank
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 client to CT scan with oral suction in case of aspiration.
ANS: A
The tube feeding should be shut off 30–60 minutes before any procedure requiring the client
to lie flat. Because the CT scan is ordered for diagnosis of client 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.
DIF: Cognitive Level: Application
MSC: NCLEX: Physiological Integrity
TOP: Nursing Process: Planning
13. The nurse is admitting a client for electrolyte disorders of unknown etiology. Which of the
following findings is most important to report to the health care provider?
a. The client’s knuckles are macerated.
b. The client uses laxatives on a daily basis.
c. The client has a history of weight fluctuations.
d. The client’s serum potassium level is 2.9 mmol/L.
ANS: D
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 client’s electrolyte disturbances,
but it does not suggest imminent life-threatening complications.
DIF: Cognitive Level: Application
Nursing
NURSINGTOP:
B.C
M Process: Assessment
T
O
MSC: NCLEX: Physiological Integrity
14. The student nurse is caring for a client who is receiving intermittent tube feedings. Which of
the following actions by the student nurse should cause the RN to intervene in the clients’
care?
a. Positions the head of the bed 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.
ANS: C
The residual volume should be checked every 4 hours not every hour. Elevate the head of bed
to a minimum of 30 degrees, but preferably 45 degrees to prevent aspiration. With intermittent
delivery is used, the head should remain elevated for 30–60 minutes after feeding. The tube is
to be flushed before and after the feeding.
DIF: Cognitive Level: Application
TOP: Nursing Process: Implementation
MSC: NCLEX: Safe and Effective Care Environment
15. The nurse is preparing to teach an 82-year-old Indigenous client who lives with an adult
daughter about ways to improve nutrition. Which of the following actions should the nurse
take first?
a. Ask the daughter about the client’s food preferences.
b. Determine who shops for groceries and prepares the meals.
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Medical-Surgical Nursing in Canada 4th Edition Lewi Test Bank
c. Question the client about how many meals per day are eaten.
d. Assure the client that culturally appropriate foods will be included.
ANS: B
The family member who shops for groceries and cooks will be in control of the client’s diet,
so the nurse will need to ensure that this family member is involved in any teaching or
discussion about the client’s nutritional needs. The other information also will be assessed and
used but will not be useful in meeting the client’s nutritional needs unless nutritionally
appropriate foods are purchased and prepared.
DIF: Cognitive Level: Application
TOP: Nursing Process: Planning
MSC: NCLEX: Health Promotion and Maintenance
16. How many grams of protein will the nurse recommend to meet the minimum daily
requirement for a client who weighs 66 kg?
a. 36
b. 53
c. 75
d. 98
ANS: B
The recommended daily protein intake is 0.8–1 g/kg of body weight, which for this client is
66 kg  0.8 g = 52.8 or 53 g/day.
DIF: Cognitive Level: Application
TOP: Nursing Process: Implementation
MSC: NCLEX: Health Promotion and Maintenance
17. The nurse receives change-of-shift
N R report
I Gabout
B.CtheMfollowing four clients. Which of the
U S
N first?
T
O
following clients should the nurse
assess
a. A client who has malnutrition associated with 4+ generalized pitting edema
b. A client whose parenteral nutrition has 10 mL of solution left in the infusion bag
c. A client whose gastrostomy tube is plugged after crushed medications were given
through the tube
d. A client who is receiving continuous enteral feedings and has new-onset crackles
throughout the lungs
ANS: D
The client data suggest aspiration has occurred and rapid assessment and intervention are
needed. The other clients also should be assessed as quickly as possible, but the data about
them do not suggest any immediately life-threatening complications.
DIF: Cognitive Level: Application
TOP: Nursing Process: Planning
MSC: NCLEX: Safe and Effective Care Environment
18. Which of the following actions should the nurse take first in order to improve calorie and
protein intake for a client who eats only about 50% of each meal because of “feeling too tired
to eat much”?
a. Teach the client 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).
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Medical-Surgical Nursing in Canada 4th Edition Lewi Test Bank
ANS: B
Eating small amounts of food frequently throughout the day is less fatiguing and will improve
the client’s ability to take in more nutrients. Teaching the client may be appropriate, but will
not address the client’s inability to eat more because of fatigue. Tube feedings or PN may be
needed if the client is unable to take in enough nutrients orally, but increasing the oral intake
should be attempted first.
DIF: Cognitive Level: Application
MSC: NCLEX: Physiological Integrity
TOP: Nursing Process: Planning
19. The nurse is caring for a client 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 client’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.
ANS: C
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.
DIF: Cognitive Level: Application
MSC: NCLEX: Physiological Integrity
TOP: Nursing Process: Implementation
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20. The nurse is caring for a client 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 client?
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
ANS: B
The client’s hypokalemia may lead to life-threatening cardiac dysrhythmias. The other
diagnoses also are appropriate for this client but are not associated with immediate risk for
fatal complications.
DIF: Cognitive Level: Application
MSC: NCLEX: Physiological Integrity
TOP: Nursing Process: Diagnosis
21. The nurse is caring for a client 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.
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Medical-Surgical Nursing in Canada 4th Edition Lewi Test Bank
d. Question the order as tube feedings are not to be delivered as a bolus.
ANS: A
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 is important to remember that the
client still needs water (1 mL/cal formula received), and this may be administered at any time
that the client can tolerate it.
DIF: Cognitive Level: Application
TOP: Nursing Process: Implementation
MSC: NCLEX: Safe and Effective Care Environment
MULTIPLE RESPONSE
1. During a busy day, the nurse admits all of the following clients to the medical-surgical unit.
Which clients are most important to refer to the dietitian for a complete nutritional
assessment? (Select all that apply.)
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
ANS: A, C, E
Weight fluctuations, use of corticosteroids, and draining or infected wounds all suggest that
the client may be at risk for malnutrition. Clients with chest pain or MI are not usually poorly
nourished. Although vomiting that lasts 5 days places a client at risk, nausea that has persisted
NURSpoor
INGnutritional
TB.COMstatus or risk for health problems caused
for 2 days does not always indicate
by poor nutrition.
DIF: Cognitive Level: Application
MSC: NCLEX: Physiological Integrity
TOP: Nursing Process: Implementation
OTHER
1. The nurse is caring for a comatose client who is receiving continuous enteral nutrition through
a soft nasogastric tube and notes the presence of new crackles in the client’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 client’s health care provider.
ANS:
A, C, D, B
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Medical-Surgical Nursing in Canada 4th Edition Lewi Test Bank
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.
DIF: Cognitive Level: Application
MSC: NCLEX: Physiological Integrity
TOP: Nursing Process: Implementation
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