NUR212CH63

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Author:
TomWruble
ID:
213239
Filename:
NUR212CH63
Updated:
2013-04-21 15:54:05
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nur212e2 Care Patients Malnutrition Obesity
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Description:
Care of Patients with Malnutrition and Obesity
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  1. (63) An older adult is admitted to the hospital with pressure ulcers and septicemia. His height is 5 feet, 10 inches (1.78 meters), and he weighs 342 pounds (155 kg). His current body mass index (BMI) is _______. (Your answer should be rounded to the nearest tenth.)
    48.9 NOT as the book indicates 48.1

    kg / meters^2
  2. (63) An older client admitted to the hospital from the nursing home refuses to eat anything on her meal tray. What instructions will the nurse give to the nursing assistant who is attempting to feed the client? Select all that apply.

    A. “Feed her the soft food because she has no teeth.”
    B. “Place the fork in her hand and leave the room.”
    C. “Sit at her level so that she can feel more comfortable.”
    D. “Take your time feeding her and don’t rush her.”
    E. “Offer her the Ensure supplement instead of feeding her.”
    F. “Ask the client what foods she likes and dislikes.”
    A, C, D, F

    The client does not have any teeth to chew food, so to prevent choking, the nursing assistant should feed her only soft food that does not require chewing.

    Sitting face to face with or at the same level of the client can help make her feel comfortable during mealtimes, thus providing more support and possibly resulting in the client choosing to eat.

    The nursing assistant should also take her time while feeding the client for safety reasons and to support the client. Individuals are more likely to eat when given a choice in food selections that consider their likes and dislikes.

    A client who refuses to eat will not likely eat when left alone. Also, if the client is confused or disoriented, a fork may be dangerous.

    A balanced nutrition meal should be encouraged before using supplements.
  3. (63) A malnourished client is being discharged on enteral nutrition products. Which suggestion from the registered dietitian does the nurse implement to make the enteral feeding experience more normal for the client?

    A. Once feeding is completed, putting equipment out of view
    B. Emphasizing the need to take iron medications before the feeding
    C. Bringing the enteral product and napkin to the client on a tray
    D. Administering the feeding product on a regular schedule
    C. Bringing the enteral product and napkin to the client on a tray

    Incorrect: Although the feeding product should be administered according to the prescribed schedule, this will not necessarily normalize the experience for the client.

    Correct: "Serving" the enteral product and napkin on a tray will help normalize the feeding experience for the client.

    Incorrect: Although iron medications may be helpful in preventing constipation, encouraging their use will not normalize the experience for the client.

    Incorrect: Although putting equipment away after use may be helpful in taking the client out of the dependent "client" role, this will not serve to normalize the feeding experience itself.
    (this multiple choice question has been scrambled)
  4. (63) T/F: Liquid dietary supplements can be substituted safely for solid food while attempting to lose weight.
    False
  5. (63) T/F: The best candidate for surgical intervention of obesity is the one with a BMI of 40 or more and a weight 75% above the ideal body weight.
    False: 40 or more and a weight 100% above the ideal body weight.
  6. (63) T/F: The least risk for malnutrition is actually seen in adult clients whose BMI is between 18.5 and 25.
    True
  7. (63) Which serum albumin level does the nurse expect to see in the healthy, ambulatory older adult client?

    A. 3.3 g/dL
    B. 4.3 g/dL
    C. 3.7 g/dL
    D. 3.9 g/dL
    B. 4.3 g/dL

    Normal is 3.5 -5.0 g/dL. Howevere, "A level of 3.9 g/dL would actually be considered low for this client."
    (this multiple choice question has been scrambled)
  8. (63) A client who is receiving total enteral nutrition (TEN) exhibits acute confusion and shallow breathing and says, "I feel weak." As the client begins to have a generalized seizure, how does the nurse interpret this client's signs and symptoms?

    A. The enteral tube is misplaced or dislodged.
    B. Abdominal distention is present.
    C. A fluid and electrolyte imbalance is present.
    D. This is refeeding syndrome.
    D. This is refeeding syndrome.

    Incorrect: If the enteral tube becomes misplaced or dislodged, the client may develop aspiration pneumonia displayed by increased temperature, increased pulse, dehydration, diminished breath sounds, and shortness of breath.

    Incorrect: Abdominal distention is most frequently accompanied by nausea and vomiting.

    Incorrect: Signs and symptoms of fluid and electrolyte problems resulting in circulatory overload can include peripheral edema, sudden weight gain, crackles, dyspnea, increased blood pressure, and bounding pulse.

    Correct: Symptoms of refeeding syndrome include shallow respirations, weakness, acute confusion, seizures, and increased bleeding tendency.
    (this multiple choice question has been scrambled)
  9. (63) A client is discharged home with an enteral feeding tube. What does the home health nurse do to determine the patency of the client's enteral tube?

    A. Tests aspirated tube contents for pH level before each feeding
    B. Instills air into the tube to check for placement and patency before each feeding
    C. Auscultates the client's abdomen for bowel sounds before each feeding
    D. Arranges for the client to have an x-ray performed periodically
    A. Tests aspirated tube contents for pH level before each feeding

    Incorrect: This traditional auscultatory method for checking enteral tube placement is not reliable, especially for the client with a small-bore tube.

    Correct: This is considered to be the most accurate method for confirming enteral tube placement.
    (this multiple choice question has been scrambled)
  10. (63) A client is placed on orlistat (Xenical) as part of a treatment regimen for morbid obesity. What side effects does the nurse tell the client to expect from using this drug?

    A. Loose stools, abdominal cramps, and nausea
    B. Palpitations, constipation, and restlessness
    C. Insomnia, dry mouth, and blurred vision
    D. Dry mouth, constipation, and insomnia
    A. Loose stools, abdominal cramps, and nausea

    insomnia
    dry mouth
    blurred vision
    palpitations
    constipation
    restlessness

    are side effects of short-term therapy drugs such as

    phentermine (Adipex-P)
    diethylpropion (Tenuate, Tenuate Dospan)
    phendimetrazine (Bontril)
    (this multiple choice question has been scrambled)
  11. (63) T/F: The client who is experiencing mental confusion is not a good candidate for bariatric surgery because the client may have difficulty complying with the postoperative treatment regimen.
    True
  12. (63) A nurse is monitoring a client who is receiving an intravenous fat emulsion (IVFE) nutritional supplement. What action does the nurse take in the event that the client develops fever, increased triglycerides, and clotting problems?

    A. Discontinues the IVFE infusion
    B. Documents the findings and continues to monitor
    C. Slows the rate of flow of the IVFE infusion
    D. Switches the infusion to total parenteral nutrition (TPN) infusion
    A. Discontinues the IVFE infusion

    Correct: For clients receiving fat emulsions, monitor for manifestations of fat overload syndrome, especially in those who are critically ill. These manifestations include fever, increased triglycerides, clotting problems, and multi-system organ failure. Discontinue the IVFE infusion, and report any of these changes to the health care provider immediately if this complication is suspected.
    (this multiple choice question has been scrambled)
  13. (63) A nurse is teaching a class of older adults in the community about engaging in "regular" exercise. What does the nurse advise them?

    A. "1 to 2 hours of cardiovascular exercise every day is a good idea."
    B. "Joining a fitness program or gym will help greatly with your exercise."
    C. "You will benefit most if you get into a group that shares your exercise goals."
    D. "Walking 20 minutes provides the same benefit as long periods of exercise."
    D. "Walking 20 minutes provides the same benefit as long periods of exercise."

    Although some people think that regular exercise has to include joining a fitness program or exercising for long periods of time, simple forms of exercise like walking 20 minutes provide the same type of benefit. Older adults can engage in this type of exercise. It does not cost money (like joining a program) and provides health benefits such as strengthening joints and improving cardiovascular health.
    (this multiple choice question has been scrambled)
  14. (63) A nurse obtains assessment data on a client who had bariatric surgery today. Which finding does the nurse report to the surgeon immediately?

    A. The client reports pain when being repositioned.
    B. Bowel sounds are not audible in all quadrants.
    C. Client's skin under the panniculus is excoriated.
    D. Urine output total is 15 mL for the past 2 hours.
    D. Urine output total is 15 mL for the past 2 hours.

    Oliguria may indicate severe postoperative complications such as anastomotic leaks or acute kidney failure.
    (this multiple choice question has been scrambled)
  15. (63) Situation: An 87-year-old woman resident from an extended-care facility has not been eating for several days. She is admitted to the hospital with a diagnosis of malnutrition. She has an enteral feeding tube placed in her left nostril. Her medications include digoxin (Lanoxin), ranitidine (Zantac), and potassium chloride elixir (Kay Ciel). The nurse who is responsible for checking the gastric pH of the feeding tube tests it and obtains a value of 6.0. This finding may indicate that the feeding tube is in the client's lungs. Is there another possible explanation for the nurse to consider?

    A. No. The feeding tube must be removed.
    B. No. The potassium effect will prevent the pH from reaching 6.0.
    C. Yes. The pH paper has expired and is giving a false reading.
    D. Yes. The client is taking Zantac.
    D. Yes. The client is taking Zantac.

    Incorrect: This finding-given the circumstances-does not mean that the tube is displaced and in the client's lungs.

    Incorrect: The potassium effect does not cause the pH to become more alkaline.

    Correct: The pH may be as high as 6.0 if the client takes certain medications, such as H2 blockers (e.g., ranitidine [Zantac], famotidine [Pepcid]).

    Incorrect: Expired pH paper will provide no data that are reliable, so it would be impossible to have a reading of "6."
    (this multiple choice question has been scrambled)
  16. (63) Situation: An 87-year-old woman resident from an extended-care facility has not been eating for several days. She is admitted to the hospital with a diagnosis of malnutrition. She has an enteral feeding tube placed in her left nostril. Her medications include digoxin (Lanoxin), ranitidine (Zantac), and potassium chloride elixir (Kay Ciel). She has developed a severe case of diarrhea. What is a possible cause?

    A. Ranitidine (Zantac)
    B. Potassium chloride (Kay Ciel)
    C. Digoxin (Lanoxin)
    D. Gastritis
    B. Potassium chloride (Kay Ciel)

    Incorrect: Diarrhea is not a frequent side effect of digoxin.

    Incorrect: Gastritis does not cause diarrhea. The other signs and symptoms of gastritis are not mentioned in this scenario.

    Correct: In some cases, diarrhea may be the result of liquid medications such as elixirs and suspensions that have a very high osmolality.

    Incorrect: Diarrhea is not a frequent side effect of ranitidine.
    (this multiple choice question has been scrambled)
  17. (63) Situation: A 45-year-old obese woman with a body mass index (BMI) of 30 has high blood pressure. After a complete physical examination, her health care provider places her on a diuretic and also prescribes orlistat (Xenical) 60 mg orally three times a day. She has been taking this medication for 4 weeks and has lost only 10 pounds. What does the nurse anticipate the health care provider will do for this client?

    A. Increase the dosage of her medication.
    B. Encourage her to decrease her activity level.
    C. Decrease the amount of her medication.
    D. Change her medication to phendimetrazine (Bontril).
    A. Increase the dosage of her medication.

    Incorrect: Phendimetrazine (Bontril) is a sympathomimetic drug that suppresses appetite for short-term use along with a structured weight management and exercise program. It acts on the central nervous system, including suppressing the appetite center in the hypothalamus. Clients with hypertension should not take this drug.

    Incorrect: The medication is being given at a low dose-60 mg. Decreasing it would make weight loss occur more slowly.

    Incorrect: All diet plans include an increase in physical activity. Having the client decrease her activity level would make her weight loss more gradual.

    Correct: The usual dosage can be 120 mg three times a day, depending on the client's response.
    (this multiple choice question has been scrambled)

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