TEST BANK INTRODUCTION TO CRITICAL CARE NURSING 7TH EDITION
Chapter06:NutritionalTherapy
1.ApatientishavingcomplicationsfromabdominalsurgeryandremainsNPO.Becauseenteraltubefeedingsa
renotpossible,thedecisionistoinitiateparenteralfeedings.Whatarethemajorcomplicationsforthistherap
y
b. Fluidandelectrolyteimbalancesandsepsis
.Apatientisbeingventilatedandhasbeenstartedonenteralfeedingswithanasogastricsmall-
borefeedingtube.Whatistheprimaryreasonthenursemustfrequentlyassesstubeplacement?
d. Topreventaspirationofthefeedings
3.Thepatientistostartparenteralnutrition.Thenurseknowstopreparewhichsiteforcatheterinsertion?
d. Subclavianvein
4.Apatienthasbeenadmittedtothecriticalcareunitafterastroke.Afterfailingaswallowstudy,thepatientispl
acedonenteralfeedings.Followingplacementofanasogastrictubefortubefeeding,whatisthenextcriticalst
ep?
c. Obtainachestradiograph.
5.Apatientsfeedingtubehasbeensuccessfullyplacedinthesmallintestinewithcontinuousflowtubefeeding
.Thenurseknowsthatthisapproachwaschosenbecause:
c. theintestinalmucosanormallyreceivesnutrientsfromthestomachinperistalticwaves
6.Apatientisbeingfedthroughanasogastrictubeplacedinhisstomach.Thenursewouldcarryoutwhichinter
ventiontominimizeaspirationrisk?
Elevatetheheadofthebed30degrees.
7.Apatientwhoisreceivingcontinuousenteralfeedingshasjustvomited250mLofmilkygreenfluid.Thisisaco
ncernbecausethismostlikelydemonstratesthatthepatienthas:
d. tube feeding intolerance.
8.Apatientisreceivingenteralfeedingsandhasjustvomited250mLofmilkygreenliquid.Thenurseholdsthetu
befeeding,whichhadbeeninfusingat100mL/hr.Thenurseknowsthatthenextactionshouldbe:
d. recheck the residual in 2hours
9.Inadditiontoresidualstomachvolume,whatotherevidencesuggestsfeedingintolerance?
a. Abdominal distention
10.Approximately5daysafterstartingtubefeedings,apatientdevelopsextremediarrhea.Astoolspecimenis
collectedtocheckforwhichpossiblecause?
a. Clostridium difficile
,11.Apatientwithacutepancreatitisisstartedonparenteralnutrition.Thestudentnurselistedpossibleinterv
entionsforthispatient.Whichinterventionneedscorrectionbeforefinalizingtheplanofcare?
b. Infuseantibioticsthroughtheintravenousline.
12.Inevaluatingapatientsnutrition,thenursewouldmonitorwhichbloodtestasthemostsensitiveindicator
ofproteinsynthesisandcatabolism?
c. Prealbumin
13.Apatientisreceivingenteraltubefeedingsandhasdevelopeddrug-
nutrientinteractions.Thenurserecognizeswhichdrugashavingthepotentialforcausingdrug-
nutrientreactions?
d. Phenytoin
14.Whichstatementistrueaboutnormalfunctionofthegastrointestinal(GI)tract?
d. Without nutritional stimulation, mucosal villi atrophy.
15.An important nutritional consideration in the elderly population is:
c. potential for drug-nutrient interaction related to polypharmacy.
16.Objectivedatadesignatingthatthenutritiongoalsarenotbeingmetinclude:
d. weight loss, elevated glucose, and dehydration
17.In trauma patients ,enteral nutrition via nasogastric tube feedings into the small bowel is best
initiated within what time frame following the injury?
a. 24hours
18.Apatientwithahistoryofemphysema,diabetes,andhyperlipidemiaisinthecriticalcareunitonaventilato
r.Thenutritionassessmentnotesthatthepatienthasaproteinandvitamindeficiencyandisunderweight.Whi
chformulafornutritionalassessmentismostappropriate?
b. Fiber-addedformula
19.Selectthephysiologicalreasoningbehindenteraltherapyasthepreferredsourceofnutritionaltherapy
d. Gut mucosa is preserved.
20.Thenurseidentifieswhichpatientatgreatestriskformalabsorptionofprotein?
b. The patient with ileitis
21.Thebestnursingapproachtopreventfeedingtubeobstructionis:
b. flushthetubeevery4hourswith20to30mLoftapwater.
22.Patientsexperiencingseverephysiologicalstressincreasetheirnutritionalrequirementsto:
c. 35kcal/kg/day
, 23.Malnutritioncontributestoinfectionriskby
b. impairing immune function
24.Apatient,whohasatubefeeding,requiresachestx-
raystudyforevaluationofacough.Toreducetheriskofaspiration,thenurse:
d. stopsfeedings10to15minutesbeforeplacingflattoobtaintheradiograph.
1.Whichstatement(s)abouttotalparenteralnutritionis(are)true?(Selectallthatapply.)
a. Assessingfluidvolumestatusandpreventinginfectionareimportantnursingconsiderations.b.
Fingerstickglucoselevelsareassessedevery6hoursandprn.
d. Totalparenteralnutrition,withaddedlipids,providesadequatelevelsofprotein,carbohydrates,andfats.
2.Whichintervention(s)is(are)criticalduringintravenouslipidadministration?(Selectallthatapply).
b. Changethetubingevery24hours.
d. Monitortriglyceridelevels.
3.Calorie-densefeedings:(Selectallthatapply.)
a. are most useful in heart failure and liver disease.
4.Risksoftotalparenteralnutritioninclude:(Selectallthatapply.)
b. elevatedbloodsugar.
c. infectionatthecathetersite.
d. volumeoverload.
5.Whichofthefollowingstatementsistrueaboutinsulinandparenteralnutrition?(Selectallthatapply.)
a. Amountofparenteralinsulinisadjustedbasedontheprevious24-hourlaboratoryvalues.
b. Insulinmaybeaddedtoaparenteralnutritionsolution.
c. Subcutaneousinsulinisusedonaslidingscaleduringparenteralnutrition.
Thecorrectorderofactionsforapatientstartingenteralnutritionwithafeedingtubeis:__
A.Initiatetubefeeding. B.Insertfeedingtube. C.Flushtubetoverifypatency. D.Obtainchestradiograph.
E.Assessresiduals. ANS: B,D,C,A,E
1.Apatienthascoronaryarterybypassgraftsurgeryandistransportedtothesurgicalintensivecareunitatnoo
n.Heisplacedonmechanicalventilation.Interprethisinitialarterialbloodgaslevels:
pH7.31
PaCO248mmHg
Bicarbonate22mEq/L
PaO2115mmHg
O2saturation99%
d. Uncompensated
respiratory
Chapter06:NutritionalTherapy
1.ApatientishavingcomplicationsfromabdominalsurgeryandremainsNPO.Becauseenteraltubefeedingsa
renotpossible,thedecisionistoinitiateparenteralfeedings.Whatarethemajorcomplicationsforthistherap
y
b. Fluidandelectrolyteimbalancesandsepsis
.Apatientisbeingventilatedandhasbeenstartedonenteralfeedingswithanasogastricsmall-
borefeedingtube.Whatistheprimaryreasonthenursemustfrequentlyassesstubeplacement?
d. Topreventaspirationofthefeedings
3.Thepatientistostartparenteralnutrition.Thenurseknowstopreparewhichsiteforcatheterinsertion?
d. Subclavianvein
4.Apatienthasbeenadmittedtothecriticalcareunitafterastroke.Afterfailingaswallowstudy,thepatientispl
acedonenteralfeedings.Followingplacementofanasogastrictubefortubefeeding,whatisthenextcriticalst
ep?
c. Obtainachestradiograph.
5.Apatientsfeedingtubehasbeensuccessfullyplacedinthesmallintestinewithcontinuousflowtubefeeding
.Thenurseknowsthatthisapproachwaschosenbecause:
c. theintestinalmucosanormallyreceivesnutrientsfromthestomachinperistalticwaves
6.Apatientisbeingfedthroughanasogastrictubeplacedinhisstomach.Thenursewouldcarryoutwhichinter
ventiontominimizeaspirationrisk?
Elevatetheheadofthebed30degrees.
7.Apatientwhoisreceivingcontinuousenteralfeedingshasjustvomited250mLofmilkygreenfluid.Thisisaco
ncernbecausethismostlikelydemonstratesthatthepatienthas:
d. tube feeding intolerance.
8.Apatientisreceivingenteralfeedingsandhasjustvomited250mLofmilkygreenliquid.Thenurseholdsthetu
befeeding,whichhadbeeninfusingat100mL/hr.Thenurseknowsthatthenextactionshouldbe:
d. recheck the residual in 2hours
9.Inadditiontoresidualstomachvolume,whatotherevidencesuggestsfeedingintolerance?
a. Abdominal distention
10.Approximately5daysafterstartingtubefeedings,apatientdevelopsextremediarrhea.Astoolspecimenis
collectedtocheckforwhichpossiblecause?
a. Clostridium difficile
,11.Apatientwithacutepancreatitisisstartedonparenteralnutrition.Thestudentnurselistedpossibleinterv
entionsforthispatient.Whichinterventionneedscorrectionbeforefinalizingtheplanofcare?
b. Infuseantibioticsthroughtheintravenousline.
12.Inevaluatingapatientsnutrition,thenursewouldmonitorwhichbloodtestasthemostsensitiveindicator
ofproteinsynthesisandcatabolism?
c. Prealbumin
13.Apatientisreceivingenteraltubefeedingsandhasdevelopeddrug-
nutrientinteractions.Thenurserecognizeswhichdrugashavingthepotentialforcausingdrug-
nutrientreactions?
d. Phenytoin
14.Whichstatementistrueaboutnormalfunctionofthegastrointestinal(GI)tract?
d. Without nutritional stimulation, mucosal villi atrophy.
15.An important nutritional consideration in the elderly population is:
c. potential for drug-nutrient interaction related to polypharmacy.
16.Objectivedatadesignatingthatthenutritiongoalsarenotbeingmetinclude:
d. weight loss, elevated glucose, and dehydration
17.In trauma patients ,enteral nutrition via nasogastric tube feedings into the small bowel is best
initiated within what time frame following the injury?
a. 24hours
18.Apatientwithahistoryofemphysema,diabetes,andhyperlipidemiaisinthecriticalcareunitonaventilato
r.Thenutritionassessmentnotesthatthepatienthasaproteinandvitamindeficiencyandisunderweight.Whi
chformulafornutritionalassessmentismostappropriate?
b. Fiber-addedformula
19.Selectthephysiologicalreasoningbehindenteraltherapyasthepreferredsourceofnutritionaltherapy
d. Gut mucosa is preserved.
20.Thenurseidentifieswhichpatientatgreatestriskformalabsorptionofprotein?
b. The patient with ileitis
21.Thebestnursingapproachtopreventfeedingtubeobstructionis:
b. flushthetubeevery4hourswith20to30mLoftapwater.
22.Patientsexperiencingseverephysiologicalstressincreasetheirnutritionalrequirementsto:
c. 35kcal/kg/day
, 23.Malnutritioncontributestoinfectionriskby
b. impairing immune function
24.Apatient,whohasatubefeeding,requiresachestx-
raystudyforevaluationofacough.Toreducetheriskofaspiration,thenurse:
d. stopsfeedings10to15minutesbeforeplacingflattoobtaintheradiograph.
1.Whichstatement(s)abouttotalparenteralnutritionis(are)true?(Selectallthatapply.)
a. Assessingfluidvolumestatusandpreventinginfectionareimportantnursingconsiderations.b.
Fingerstickglucoselevelsareassessedevery6hoursandprn.
d. Totalparenteralnutrition,withaddedlipids,providesadequatelevelsofprotein,carbohydrates,andfats.
2.Whichintervention(s)is(are)criticalduringintravenouslipidadministration?(Selectallthatapply).
b. Changethetubingevery24hours.
d. Monitortriglyceridelevels.
3.Calorie-densefeedings:(Selectallthatapply.)
a. are most useful in heart failure and liver disease.
4.Risksoftotalparenteralnutritioninclude:(Selectallthatapply.)
b. elevatedbloodsugar.
c. infectionatthecathetersite.
d. volumeoverload.
5.Whichofthefollowingstatementsistrueaboutinsulinandparenteralnutrition?(Selectallthatapply.)
a. Amountofparenteralinsulinisadjustedbasedontheprevious24-hourlaboratoryvalues.
b. Insulinmaybeaddedtoaparenteralnutritionsolution.
c. Subcutaneousinsulinisusedonaslidingscaleduringparenteralnutrition.
Thecorrectorderofactionsforapatientstartingenteralnutritionwithafeedingtubeis:__
A.Initiatetubefeeding. B.Insertfeedingtube. C.Flushtubetoverifypatency. D.Obtainchestradiograph.
E.Assessresiduals. ANS: B,D,C,A,E
1.Apatienthascoronaryarterybypassgraftsurgeryandistransportedtothesurgicalintensivecareunitatnoo
n.Heisplacedonmechanicalventilation.Interprethisinitialarterialbloodgaslevels:
pH7.31
PaCO248mmHg
Bicarbonate22mEq/L
PaO2115mmHg
O2saturation99%
d. Uncompensated
respiratory
