Complete Test Bank for Nutrition:
Concepts Full Chapter Coverage with
NCLEX-Style Questions and Rationales
The nurse is concerned about pulmonary aspiration when providing the patient with an
intermittent tube feeding. Which action is the priority?
a. Observe the color of gastric contents.
b. Verify tube placement before feeding.
c. Add blue food coloring to the enteral formula.
d. Run the formula over 12 hours to decrease overload. - answersANS: B
A major cause of pulmonary aspiration is regurgitation of formula. The nurse needs to
verify tube placement and elevate the head of the bed 30 to 45 degrees during feedings
and for 2 hours afterward. While observing the color of gastric contents is a component,
it is not the priority component; pH is the primary component. The addition of blue food
coloring to enteral formula to assist with detection of aspirate is no longer used. Do not
hang formula longer than 4 to 8 hours. Formula becomes a medium for bacterial growth
after that length of time.
The patient is to receive multiple medications via the nasogastric tube. The nurse is
concerned that the tube may become clogged. Which action is best for the nurse to
take?
a. Instill nonliquid medications without diluting.
b. Irrigate the tube with 60 mL of water after all medications are given.
c. Mix all medications together to decrease the number of administrations.
d. Check with the pharmacy for availability of the liquid forms of medications. -
answersANS: D
Use liquid medications when available to prevent tube occlusion. Irrigate with 30 mL of
water before and after each medication per tube. Completely dissolve crushed
medications in liquid if liquid medication is not available. Read pharmacological
information on compatibility of drugs and formula before mixing medications.
The patient has just started on enteral feedings, and the patient is reporting abdominal
cramping. Which action will the nurse take next?
a. Slow the rate of tube feeding.
b. Instill cold formula to "numb" the stomach.
c. Change the tube feeding to a high-fat formula.
d. Consult with the health care provider about prokinetic medication. - answersANS: A
One possible cause of abdominal cramping is a rapid increase in rate or volume.
Lowering the rate of delivery may increase tolerance. Another possible cause of
,abdominal cramping is the use of cold formula. The nurse should warm the formula to
room temperature. High-fat formulas are also a cause of abdominal cramping. Consult
with the health care provider regarding prokinetic medication for increasing gastric
motility for delayed gastric emptying.
The patient has just been started on an enteral feeding and has developed diarrhea
after being on the feeding for 2 hours. What does the nurse suspect is the most likely
cause of the diarrhea?
a. Antibiotic therapy
b. Clostridium difficile
c. Formula intolerance
d. Bacterial contamination - answersANS: C
Hyperosmolar formulas can cause diarrhea or formula intolerance. If that is the case,
the solution is to lower the rate, dilute the formula, or change to an isotonic formula.
Antibiotics destroy normal intestinal flora and disturb the internal ecology, allowing for
Clostridium difficile toxin buildup. However, this takes time (more than 2 hours), and no
indication suggests that this patient is on antibiotics. Bacterial contamination of the
feeding usually occurs when feedings are left hanging for longer than 8 hours.
A patient develops a foodborne disease from Escherichia coli. When taking a health
history, which food item will the nurse most likely find the patient ingested?
a. Improperly home-canned food
b. Undercooked ground beef
c. Soft cheese
d. Custard - answersANS: B
Undercooked ground beef is the usual food source for Escherichia coli. Botulism is
associated with improperly home-canned foods. Soft cheese is the usual food source
for listeriosis. Custards are associated with salmonellosis andStaphylococcus.
The nurse is caring for a patient receiving total parenteral nutrition (TPN). Which action
will the nurse take?
a. Run lipids for no longer than 24 hours.
b. Take down a running bag of TPN after 36 hours.
c. Clean injection port with alcohol 5 seconds before and after use.
d. Wear a sterile mask when changing the central venous catheter dressing. -
answersANS: D
During central venous catheter dressing changes, always use a sterile mask and
gloves, and assess insertion sites for signs and symptoms of infection. To avoid
infection, change the TPN infusion tubing every 24 hours, and do not hang a single
container of PN for longer than 24 hours or lipids longer than 12 hours.
The patient is having at least 75% of nutritional needs met by enteral feeding, so the
health care provider has ordered the parenteral nutrition (PN) to be discontinued.
However, the nurse notices that the PN infusion has fallen behind. What should the
nurse do?
a. Increase the rate to get the volume caught up before discontinuing.
, b. Stop the infusion as ordered.
c. Taper infusion gradually.
d. Hang 5% dextrose. - answersANS: C
Sudden discontinuation of PN can cause hypoglycemia. PN must be tapered off.
Usually, 10% dextrose is infused when PN solution is suddenly discontinued. Too rapid
administration of hypertonic dextrose (PN) can result in an osmotic diuresis and
dehydration. If an infusion falls behind schedule, the nurse should not increase the rate
in an attempt to catch up.
The patient is on parenteral nutrition and is lethargic. The patient reports thirst and
headache and has had increased urination. Which problem does the nurse prepare to
address?
a. Hyperglycemia
b. Hypoglycemia
c. Hypercapnia
d. Hypocapnia - answersANS: A
Signs and symptoms of hyperglycemia are thirst, headache, lethargy, and increased
urination. Hypocapnia is not associated with parenteral nutrition. Hypercapnia increases
oxygen consumption and increases CO2 levels. Ventilator-dependent patients are at
greatest risk for this. Hypoglycemia is characterized by diaphoresis, shakiness,
confusion, and loss of consciousness.
In providing diabetic teaching for a patient with type 1 diabetes mellitus, which
instructions will the nurse provide to the patient?
a. Insulin is the only consideration that must be taken into account.
b. Saturated fat should be limited to less than 7% of total calories.
c. Nonnutritive sweeteners can be used without restriction.
d. Cholesterol intake should be greater than 200 mg/day. - answersANS: B
The diabetic patient should limit saturated fat to less than 7% of total calories and
cholesterol intake to less than 200 mg/day. Type 1 diabetes requires both insulin and
dietary restrictions for optimal control. Nonnutritive sweeteners can be eaten as long as
the recommended daily intake levels are followed.
The patient with cardiovascular disease is receiving dietary instructions from the nurse.
Which information from the patient indicates teaching is successful?
a. Maintain a prescribed carbohydrate intake.
b. Eat fish at least 5 times per week.
c. Limit trans fat to less than 1%.
d. Avoid high-fiber foods. - answersANS: C
American Heart Association guidelines recommend limiting saturated fat to less than
7%, trans fat to less than 1%, and cholesterol to less than 300 mg/day. Diet therapy
includes eating fish at least 2 times per week and eating whole grain high-fiber foods.
Maintaining a prescribed carbohydrate intake is necessary for diabetes mellitus.
Concepts Full Chapter Coverage with
NCLEX-Style Questions and Rationales
The nurse is concerned about pulmonary aspiration when providing the patient with an
intermittent tube feeding. Which action is the priority?
a. Observe the color of gastric contents.
b. Verify tube placement before feeding.
c. Add blue food coloring to the enteral formula.
d. Run the formula over 12 hours to decrease overload. - answersANS: B
A major cause of pulmonary aspiration is regurgitation of formula. The nurse needs to
verify tube placement and elevate the head of the bed 30 to 45 degrees during feedings
and for 2 hours afterward. While observing the color of gastric contents is a component,
it is not the priority component; pH is the primary component. The addition of blue food
coloring to enteral formula to assist with detection of aspirate is no longer used. Do not
hang formula longer than 4 to 8 hours. Formula becomes a medium for bacterial growth
after that length of time.
The patient is to receive multiple medications via the nasogastric tube. The nurse is
concerned that the tube may become clogged. Which action is best for the nurse to
take?
a. Instill nonliquid medications without diluting.
b. Irrigate the tube with 60 mL of water after all medications are given.
c. Mix all medications together to decrease the number of administrations.
d. Check with the pharmacy for availability of the liquid forms of medications. -
answersANS: D
Use liquid medications when available to prevent tube occlusion. Irrigate with 30 mL of
water before and after each medication per tube. Completely dissolve crushed
medications in liquid if liquid medication is not available. Read pharmacological
information on compatibility of drugs and formula before mixing medications.
The patient has just started on enteral feedings, and the patient is reporting abdominal
cramping. Which action will the nurse take next?
a. Slow the rate of tube feeding.
b. Instill cold formula to "numb" the stomach.
c. Change the tube feeding to a high-fat formula.
d. Consult with the health care provider about prokinetic medication. - answersANS: A
One possible cause of abdominal cramping is a rapid increase in rate or volume.
Lowering the rate of delivery may increase tolerance. Another possible cause of
,abdominal cramping is the use of cold formula. The nurse should warm the formula to
room temperature. High-fat formulas are also a cause of abdominal cramping. Consult
with the health care provider regarding prokinetic medication for increasing gastric
motility for delayed gastric emptying.
The patient has just been started on an enteral feeding and has developed diarrhea
after being on the feeding for 2 hours. What does the nurse suspect is the most likely
cause of the diarrhea?
a. Antibiotic therapy
b. Clostridium difficile
c. Formula intolerance
d. Bacterial contamination - answersANS: C
Hyperosmolar formulas can cause diarrhea or formula intolerance. If that is the case,
the solution is to lower the rate, dilute the formula, or change to an isotonic formula.
Antibiotics destroy normal intestinal flora and disturb the internal ecology, allowing for
Clostridium difficile toxin buildup. However, this takes time (more than 2 hours), and no
indication suggests that this patient is on antibiotics. Bacterial contamination of the
feeding usually occurs when feedings are left hanging for longer than 8 hours.
A patient develops a foodborne disease from Escherichia coli. When taking a health
history, which food item will the nurse most likely find the patient ingested?
a. Improperly home-canned food
b. Undercooked ground beef
c. Soft cheese
d. Custard - answersANS: B
Undercooked ground beef is the usual food source for Escherichia coli. Botulism is
associated with improperly home-canned foods. Soft cheese is the usual food source
for listeriosis. Custards are associated with salmonellosis andStaphylococcus.
The nurse is caring for a patient receiving total parenteral nutrition (TPN). Which action
will the nurse take?
a. Run lipids for no longer than 24 hours.
b. Take down a running bag of TPN after 36 hours.
c. Clean injection port with alcohol 5 seconds before and after use.
d. Wear a sterile mask when changing the central venous catheter dressing. -
answersANS: D
During central venous catheter dressing changes, always use a sterile mask and
gloves, and assess insertion sites for signs and symptoms of infection. To avoid
infection, change the TPN infusion tubing every 24 hours, and do not hang a single
container of PN for longer than 24 hours or lipids longer than 12 hours.
The patient is having at least 75% of nutritional needs met by enteral feeding, so the
health care provider has ordered the parenteral nutrition (PN) to be discontinued.
However, the nurse notices that the PN infusion has fallen behind. What should the
nurse do?
a. Increase the rate to get the volume caught up before discontinuing.
, b. Stop the infusion as ordered.
c. Taper infusion gradually.
d. Hang 5% dextrose. - answersANS: C
Sudden discontinuation of PN can cause hypoglycemia. PN must be tapered off.
Usually, 10% dextrose is infused when PN solution is suddenly discontinued. Too rapid
administration of hypertonic dextrose (PN) can result in an osmotic diuresis and
dehydration. If an infusion falls behind schedule, the nurse should not increase the rate
in an attempt to catch up.
The patient is on parenteral nutrition and is lethargic. The patient reports thirst and
headache and has had increased urination. Which problem does the nurse prepare to
address?
a. Hyperglycemia
b. Hypoglycemia
c. Hypercapnia
d. Hypocapnia - answersANS: A
Signs and symptoms of hyperglycemia are thirst, headache, lethargy, and increased
urination. Hypocapnia is not associated with parenteral nutrition. Hypercapnia increases
oxygen consumption and increases CO2 levels. Ventilator-dependent patients are at
greatest risk for this. Hypoglycemia is characterized by diaphoresis, shakiness,
confusion, and loss of consciousness.
In providing diabetic teaching for a patient with type 1 diabetes mellitus, which
instructions will the nurse provide to the patient?
a. Insulin is the only consideration that must be taken into account.
b. Saturated fat should be limited to less than 7% of total calories.
c. Nonnutritive sweeteners can be used without restriction.
d. Cholesterol intake should be greater than 200 mg/day. - answersANS: B
The diabetic patient should limit saturated fat to less than 7% of total calories and
cholesterol intake to less than 200 mg/day. Type 1 diabetes requires both insulin and
dietary restrictions for optimal control. Nonnutritive sweeteners can be eaten as long as
the recommended daily intake levels are followed.
The patient with cardiovascular disease is receiving dietary instructions from the nurse.
Which information from the patient indicates teaching is successful?
a. Maintain a prescribed carbohydrate intake.
b. Eat fish at least 5 times per week.
c. Limit trans fat to less than 1%.
d. Avoid high-fiber foods. - answersANS: C
American Heart Association guidelines recommend limiting saturated fat to less than
7%, trans fat to less than 1%, and cholesterol to less than 300 mg/day. Diet therapy
includes eating fish at least 2 times per week and eating whole grain high-fiber foods.
Maintaining a prescribed carbohydrate intake is necessary for diabetes mellitus.
