Roth 10e NCLEX Chapter 22

MULTIPLE CHOICE 1. The nurse is determining how much protein a post-surgical client requires. Which of the

following would be an appropriate amount of protein for the nurse to recommend for the postsurgical client?
a. 50 to 80 grams b. 60 to 90 grams ANS: C c. 80 to 100 grams d. 100 to 120 grams

Because protein losses following surgery can be significant and because protein is especially needed then to rebuild tissue, control edema, avoid shock, resist infection, and transport fats, a high-protein diet of 80 to 100 grams a day may be recommended.
PTS: 1 REF: Postsurgery Nutritional Care

2. The nurse is caring for a client who will receive enteral nutrition through a PEG tube. The

client also has a condition that inhibits digestion and absorption of nutrients. What type of enteral nutrition formula will the nurse select for this client?
a. elemental b. modualr ANS: A c. polymeric d. renal

Clients who are able to digest and absorb nutrients can be given polymeric formulas. Clients who have limited ability to digest or absorb nutrients may be given elemental or hydrolyzed formulas. Modular formulas can be used as supplements to other formulas or for developing customized formulas for certain clients. This client was not identified as having renal disease, so a renal formula would be inappropriate.
PTS: 1 REF: The Client Receiving Enteral Nutrition

3. A nurse is caring for a client who is receiving enteral nutrition via a nasogastric tube at a rate

of 50ml/hour over 24 hours. The nurse notes that the client is also now receiving the drug phenytoin. The nurse notes that there is a food drug interaction with this drug. How will the nurse alter the clients feeding to avoid the food-drug interaction?
a. Administer the medication at midnight c. No change to the tube feeding protocol

and turn off the tube feeding until 6:00 is necessary because the client is not am. eating food. b. Decrease the tube feeding rate by 50% d. Stop the tube feeding for an hour until the drug is discontinued. before the drug is administered until an hour after.
ANS: D

There is a food-drug interaction between the phenytoin and the tube feeding formula, so it is necessary to separate administration of the tube feeding with administration of the medication. The tube feeding should be stopped for an hour before the drug is administered until an hour after.
PTS: 1 4. REF: The Client Receiving Enteral Nutrition

A client who is been receiving enteral nutrition now has pneumonia. What nutrition related complication would the nurse say could be related to development of pneumonia in this client?
a. Aspiration of formula from the feeding c. There are no nutrition complications

tube.
b. Fluid retention associated with high

sodium intake
ANS: A

that could contribute to development of pneumonia. d. Tube feeding being delivered at too low a rate

Aspiration occurs when some of the formula enters the lung and can cause the client to develop pneumonia.
PTS: 1 REF: Possible Complications with Enteral Nutrition

5. The nurse is caring for a client with serious burns who is unable to eat. What would the nurse

do to ensure the client is getting adequate nutrition? Select the best answer.
a. Assess the client and immediately c. Wait one week and see if the clients

begin either tube feeding or parenteral condition improves enough that they feeding as appropriate. client can eat. b. Immediately begin tube feedings. d. Wait two days and if the client still cannot eat, begin parenteral feeding.
ANS: A

If the client is unable to eat, either tube feedings or parenteral feedings, whichever is more appropriate, should be started immediately.
PTS: 1 REF: The Client With Burns

6. The nurse assesses a client with AIDS and finds the clients temperature is 2 degrees

Fahrenheit above normal. The nurse knows that this client will need more calories because fever increases the basal metabolic rate (BMR). The nurse would calculate that this clients BMR is increased by what percent over normal?
a. 7% b. 14% c. 17% d. 22%

ANS: B Fever is a hypermetabolic state in which each degree of fever raises the BMR by 7%. Since this clients temperature is 2 degrees Fahrenheit above normal, the BMR is elevated 14%

PTS: 1 MULTIPLE RESPONSE

REF: The Client with Infection

1. A client is scheduled to have surgery in 4 weeks, and it was determined that the nutritional

status of the client needs to be improved. Which of the following nutrients would the nurse identify as being of particular concern for a client about to have surgery? Select all that apply
a. fat b. protein c. vitamin A ANS: B, C, D, E, F d. vitamin C e. vitamin K f. zinc

Protein is needed for wound healing, tissue building, and blood regeneration. Extra carbohydrates will be converted to glycogen and stored to help provide energy after surgery, when needs are high and when clients may be unable to eat normally. The B vitamins are needed for the increased metabolism, vitamins A and C and zinc for wound healing, vitamin D for the absorption of calcium, and vitamin K for proper clotting of the blood.
PTS: 1 REF: Presurgery Nutritional Care

2. Twenty minutes after eating a meal, a gastric surgery client begins to experience dizziness,

cramps, and vomiting. The nurse recognizes the symptoms of dumping syndrome and recommends the client avoid which of the following foods? Select all that apply.
a. candy bars b. eggs c. fruit juice ANS: A, C, D, F d. large amounts of fluid with meals e. red meat f. regular soda

Sometimes following gastric surgery, dumping syndrome occurs within 15 to 30 minutes after eating. This is characterized by dizziness, weakness, cramps, vomiting, and diarrhea. To prevent dumping syndrome, the diet should be high in protein and fat, and carbohydrates especially concentrated sweets--should be restricted. Candy bars, fruit juice and regular soda are all high in concentrated sugars. Large amounts of fluids should not be consumed with meals. Fluids consumed with a meal should be limited to 4 oz.
PTS: 1 REF: Postsurgery Nutritional Care

3. The visiting nurse is caring for a client who has AIDS. At the nurses most recent visit, the

nurse notices that the client has lost weight and discerns that the client is experiencing anorexia. The nurse knows there are several issues that could cause anorexia in a client with AIDS. Which of the following would the nurse say could be causing the clients loss of appetite? Select all that apply.
a. altered taste b. dementia c. depression ANS: A, B, C, D, E, F d. medications e. oral infections f. pain

AIDS clients commonly experience serious protein-energy malnutrition and, thus, body wasting. There are several causes of reduced food intake in AIDS clients. Some of these are medications, oral infections, altered taste, fever, pain, depression, dysphagia, and dementia.
PTS: 1 NUMERIC RESPONSE 1. A client who weighed 80 kilograms was given an intravenous solution that contained 500 REF: Problems Related to Feeding AIDS Clients; Table 22-3

calories immediately after surgery. This was the clients only calorie intake for the following 24-hour period. The nurse estimates the clients daily energy needs to be 40 calories per kg of body weight. What will the nurse determine the clients energy deficit to be for the 24 hours post surgery?
ANS:

2700 calories The estimated daily calorie requirement for adults after surgery is 35 to 45 calories per kilogram of body weight. Calculation: 80 kg x 40 kcal/kg=3200 kcal 500 kcal=2700 calories
PTS: 1 REF: Postsurgery Nutritional Care