Chapter 55: Nutritional Supplements

Multiple Choice

1. A patient is receiving a nutritional supplement via an enteral feeding tube. The nurse will monitor for which common adverse effect?

a. Diarrhea b. Constipation c. Fluid overload d. Heartburn

ANS: A

Diarrhea is the most common result of the gastrointestinal intolerance that occurs with nutritional supplementation.

DIF: COGNITIVE LEVEL: Understanding (Comprehension)

TOP: NURSING PROCESS: Assessment

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort a. Ensure Plus b. Moducal c. Propac d. Microlipid

2. An older adult patient needs to receive an enteral supplement to improve her overall nutritional status. When considering enteral supplements, the nurse notes that which formulation provides complex nutrients?

ANS: A

Ensure Plus is a polymeric formulation that contains complex nutrients, including proteins, carbohydrates, and fats. Moducal provides carbohydrates only; Propac is a protein formulation, and Microlipid supplies only fats (see Box 55-1).

DIF: COGNITIVE LEVEL: Understanding (Comprehension)

TOP: NURSING PROCESS: Planning

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies a. Central total parenteral nutrition b. Peripheral parenteral nutrition c. Oral nutritional supplements with meals d. Nasogastric enteral supplementation

3. A woman has been receiving both radiation and chemotherapy for her cancer. Lately, she has developed anorexia caused by the treatments, so she needs short-term nutrition supplementation. The nurse anticipates that the physician will initiate which therapy?

ANS: B

Peripheral parenteral nutrition is indicated for anorexia caused by radiation or cancer chemotherapy. Total parenteral nutrition is indicated for more long-term use. The other options are incorrect.

DIF: COGNITIVE LEVEL: Applying (Application)

TOP: NURSING PROCESS: Assessment

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies a. Dehydration b. Hyperglycemia c. Dumping syndrome d. Rebound hypoglycemia

4. During the night shift, a patient’s total parenteral nutrition (TPN) infusion ran out, and the nurse discovered that there was no TPN solution on hand to continue the infusion. The pharmacy is closed and will not reopen for 5 hours. The nurse will have to implement measures to prevent which consequence of abruptly discontinuing TPN infusions?

ANS: D

Rebound hypoglycemia may occur if TPN is discontinued abruptly. It may be prevented by infusion of 10% glucose in situations in which TPN must be stopped abruptly. The other options are incorrect.

DIF: COGNITIVE LEVEL: Applying (Application)

TOP: NURSING PROCESS: Implementation

MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential a. Diarrhea b. Phlebitis c. Hypernatremia d. Hypoglycemia

5. When monitoring a patient who has been receiving peripheral parenteral nutrition for more than 3 weeks, the nurse will watch for which potential complication?

ANS: B

The long-term administration of nutritional supplements via a peripheral vein may lead to phlebitis and, possibly, the loss of a limb.

DIF: COGNITIVE LEVEL: Applying (Application)

TOP: NURSING PROCESS: Evaluation

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies a. Infection b. Hypoglycemia c. Hyperglycemia d. Fluid overload

6. A patient has been receiving total parenteral nutrition. Upon assessment, the nurse notes these assessment findings: blood pressure 150/92 mm Hg (elevated from previous readings); pulse rate 110 beats/min and weak; pitting edema on both ankles; and new-onset confusion. The nurse suspects that the patient is experiencing which condition?

ANS: D

Fluid overload may occur with parenteral nutrition. It is manifested by weak pulse, hypertension, tachycardia, confusion, decreased urine output, and pitting edema.

DIF: COGNITIVE LEVEL: Analyzing (Analysis)

TOP: NURSING PROCESS: Evaluation

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies a. 10% dextrose in water b. 20% dextrose in water c. 0.9% sodium chloride d. Lactated Ringer’s solution

7. The peripheral parenteral nutrition bag that has been infusing into the patient is empty, and the nurse realizes that the next bag is not ready. The nurse should immediately hang which of these intravenous solutions until the new bag arrives?

ANS: A

If intravenous parenteral nutrition is discontinued abruptly, rebound hypoglycemia may occur. This can be prevented with infusion of 5% to 10% glucose until the parenteral nutrition infusion is ready. For peripheral infusions, the dextrose must not be more than 10%.

DIF: COGNITIVE LEVEL: Applying (Application)

TOP: NURSING PROCESS: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies a. Multivitamin solution b. Phenytoin (Dilantin) c. Metoclopramide (Reglan) d. Warfarin (Coumadin)

8. The nurse is preparing to administer medications to a patient who is receiving a feeding via a gastric tube. When reviewing the patient’s medication list, the nurse notes a potential concern about a food-drug interaction if which medication is listed?

ANS: B

Tube feedings can reduce the absorption of phenytoin, which may result in seizures. It is recommended that tube feedings be held for at least 2 hours before and after the administration of phenytoin.

DIF: COGNITIVE LEVEL: Applying (Application)

TOP: NURSING PROCESS: Planning

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies a. Jevity b. Ensure Plus c. Glucerna d. Polycose

9. A patient with type 2 diabetes will be receiving a nasogastric tube feeding for a few days. The nurse expects which type of formula to be used?

ANS: C

Glucerna is a formulation designed for use in patients with impaired glucose tolerance (e.g., diabetic patients). The other options are not designed for patients with diabetes.

DIF: COGNITIVE LEVEL: Applying (Application)

TOP: NURSING PROCESS: Planning

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies a. Vivonex Plus, an elemental formulation b. Osmolite, a polymeric formulation c. Glucerna, a formulation for impaired glucose tolerance d. Polycose, a modular formulation that contains carbohydrates

10. A patient with a partial bowel obstruction will be given a 1-week course of enteral tube feeding via a nasogastric tube. Which formulation is appropriate for this patient?

ANS: A

Elemental formulations are enteral supplements that require minimal digestion and are indicated for patients with pancreatitis, partial bowel obstruction, irritable bowel disease, and other problems. The other options are incorrect.

DIF: COGNITIVE LEVEL: Applying (Application)

TOP: NURSING PROCESS: Planning

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

Multiple Response

1. The nurse is administering a parenteral nutrition infusion to a patient. The nurse will implement which measures to prevent infection? (Select all that apply.)

a. Change the intravenous tubing set every 72 hours.

b. Change the intravenous tubing set every time a new bag is added to the infusion.

c. Use a 1.2-micron filter with each tubing set.

d. Monitor the patient’s temperature every shift during the infusion.

e. Report any increase in the patient’s temperature over 100° F (37.8° C).

ANS: B, C, E

To prevent infection, parenteral nutrition tubing is changed every time a new bag is added to the infusion. A 1.2-micron filter is used to trap bacteria. Record the patient’s temperature every 4 hours during the infusion, and report to the prescriber immediately any increase in temperature over 100° F (37.8° C).

DIF: COGNITIVE LEVEL: Applying (Application)

TOP: NURSING PROCESS: Implementation

MSC: NCLEX: Safe and Effective Care Environment: Management of Care

Completion

1. The total parenteral nutrition (TPN) order reads, “Infuse TPN #2 over 24 hours.” Bag #2 of TPN contains 1800 mL. At what rate will the nurse set the infusion pump? _______

ANS:

DIF: COGNITIVE LEVEL: Applying (Application)

TOP: NURSING PROCESS: Implementation

MSC: NCLEX: Safe and Effective Care Environment: Management of Care