Angina, also called angina pectoris, is often described as squeezing, pressure,

heaviness, tightness or pain in your chest

A myocardial infarction (commonly called a heart attack) is an extremely dangerous

condition caused by a lack of blood flow to your heart muscle. The lack of blood
flow can occur because of many different factors but is usually related to a blockage in
one or more of your heart's arteries.

Peripheral artery disease (also called peripheral arterial disease) is a common

circulatory problem in which narrowed arteries reduce blood flow to your limbs.
When you develop peripheral artery disease (PAD), your legs or arms — usually your
legs — don't receive enough blood flow to keep up with demand.

Cardiac sphincter is located at the lower esophagus, which prevents backflow of stomach
contents into the esophagus

Nurse Kathryn is changing the central line dressing of a client receiving parenteral
nutrition (PN) and notes that the catheter insertion site appears reddened. The nurse
should assess which of the following first? *
1/1
Expiration date on the bag
Time of last dressing change.
Client's temperature

Tightness of the tuning connections

Nurse Daniel is caring for an anorexic client who is having total parenteral nutrition
solution for the first time. Which of the following assessments requires the most
immediate attention? *
1/1
Dry sticky mouth
Blood glucose of 210 mg/dl

Fasting blood sugar of 98 mg/dL

Temperature of 100° Fahrenheit

Patient Liza is asked to manage fluid restrictions even at home. As a nurse doing the
discharge instructions, which of the following is the best intervention to measure
fluids? *
0/1
Usual cup/glass of patient; take note of refills
Fill 1,000 ml of fluid and drink it all day.
Use household measurement
Cup with increments
Correct answer
Cup with increments

Matteo, your patient, is receiving parenteral nutrition (PN) in the home setting has a
weight gain of 5 lb in 1 week. The nurse next assesses the client to identify the
presence of which of the following? *
1/1
Hypotension
Crackles upon auscultation

Thirst
Polyuria

Dwayne is receiving nutrition via parenteral nutrition (PN). A nurse assesses the client
for complications of the therapy and assesses the client for which of the following
signs of hyperglycemia? *
1/1
Thirst, blurred vision, and diuresis.

Fatigue, increased sweating, and heat intolerance.

High-grade fever, chills, and increased urination.
Coarse dry hair, weakness, and fatigue.

Nurse Chris is conducting a follow-up home visit to a client who has been discharged
with a parenteral nutrition (PN). Which of the following should the nurse most closely
monitor in this kind of therapy? *
1/1
Temperature and weight

Blood pressure and pulse rate

Height and weight
Oxygen Saturation and temperature

You are handling a patient who had post-resection of paralytic ileus and needs bowel
rest. Based on your understanding, which is not indicated to the patient? *
1/1
Peripherally inserted central catheter (PICC) line
PEG tube

Subclavian line
Central venous catheter

You are handling a patient with food intolerance and dumping syndrome. The doctor
has ordered bolus feeding. Which of the following is not a principle when
administration to bolus feeding? *
1/1
observe frequency of feeding about four to six times per day
observe usual volume of of 250–400 mL per feeding
electronic pump is not indicated
maintain delivery from 30 to 60 minutes

You are handling a patient with chronic pancreatitis, which of the following is the most
appropriate diet? *
1/1
low fiber diet
fat restricted diet

high fiber diet

High calorie, high protein

You are handling a patient with paralytic ileus and performing pre-operation
orientation and preparation for tomorrow's bowel resection. Which of the following
diets is the most appropriate during this time? *
1/1
fat restricted diet
low fiber diet

lactose restricted diet

high fiber diet

Marino, a 60-year-old patient who was diagnosed of stroke and has garbled speech.
What type of diet do you expect the patient to be prescribed after a speech
evaluation? *
1/1
Mechanically altered diet with thin liquids
Full liquid diet
Mechanically altered diet with nectar thick liquids

Soft diet
You are handling Manuel, who is currently on diet as tolerated (DAT). Upon evaluation
of his blood test, his cholesterol is elevated. Which of the following strategies would
help a client achieve a low-fat diet? *
1/1
Substitute whole wheat bread for white bread.
Substitute margarine for butter.
Limit portion sizes of meat.

Eat more fruit in place of vegetables.

You are handling a patient who shows signs of increase swallowing ability. What
important step should the nurse take before the patient is started on oral feedings? *
0/1
Evaluate the families perception of the oral feedings
Assess patient allergies to lactose and gluten.

Assess the patient’s understanding about oral feedings

Try sips of water.
Correct answer
Try sips of water.

Which among the following is not recommended to a patient on clear liquid diet? *
1/1
Clear Broths
Eggnog

Grape Juice
Bouillon

Ruane, your patient came into the ER with projectile vomiting and unable to tolerate
oral feeding since last night. Based on your understanding, which among the following
diet would be the most appropriate? *
0/1
Bland diet
Soft diet
Nothing Per Orem
Clear liquids

Correct answer
Nothing Per Orem

Which of the following statements is correct about post-operative diet? *

1/1
There is a lot of evidences to support a slow diet progression after surgery.

Post-operative clients are started with full liquid diet after 2 hours post-operation.
Dietary restrictions are not necessarily helpful in relieving flatulence, nausea, or vomiting
secondary to anesthesia.
Most patients can tolerate a regular diet by the first or second postoperative meal.
Correct answer
Most patients can tolerate a regular diet by the first or second postoperative meal.

Your patient asks, "which vitamin aids in iron absorption?" *

1/1
vitamin E
vitamin D
vitamin C

vitamin B

Monica, a client who is recovering from a surgery has been ordered a change from a
clear liquid diet to a full liquid diet. The nurse would offer which full liquid item to the
client? *
1/1
Bouillion
Black coffee
Pudding

Popsicle

You are handling Mark, a patient who is on soft diet for several days, which of the
following data is the most relevant you should ask? *
1/1
Bowel movement

Intake and quantity

Changes in food preference
Eating habits

Mara, your patient on full liquid diet vomited due to stomach upset. As a nurse which
of the following is not an appropriate health teaching? *
0/1
Do not mix hot and cold goods
Broth based soups, warm tea with mint or ginger ale
Good oral health
Eat small quantity hot meals
Correct answer
Eat small quantity hot meals

A patient who has a colostomy is complaining about having excess gas. You ask the
patient to tell you what he has ate in the past 48 hours. Which food would you suspect
is causing the patient excessive gas?
a. Cherries, Radishes, and Watermelon
b. Caraway seeds, tomato soup, and eggs
c. Chicken, grapes, and raspberries
d. Squash, Spinach, and Pickles
Correct Answer A
Cherries, Radishes, and Watermelon are gas causing foods and should be decreased
in consummation if a patient is experiencing excess gas.
A patient with anemia would benefit from which diet?
a. Legumes, organ meat, and dark green leafy vegetables
b. Nuts and seeds, fruits, and soy products
c. Vegetables, fish, and pasta
d. Grains, berries, and organic vegetables
Correct answer A.
A patient with anemia needs food high in iron, therefore, legumes, organ meat, and dark
green leafy vegetables are the best choice.
A patient is suffering from a broken jaw. Which foods would be most beneficial for this
patient?
a. Carrots, fried chicken, and cereal
b. Soup, pudding, and ice cream
c. Rice, watermelon, and smoked fish
d.Tacos, peanuts, and fresh broccoli
Correct Answer B.
A patient with a broken jaw needs foods that require no chewing. Soup, pudding, and
ice cream meet these qualifications.
A patient is post-opt from gallbladder surgery and is ordered a clear liquid diet. Which of
the selection can the patient have?
a. Apple Juice
b. Vanilla Custard
c. Fudge Popsicle
d. Creamy Chicken Soup
Correct Answer A.
Clear liquids are foods that are transparent to light and are liquid at body temperature.
Apple juice meets these requirements.
You have a patient who just had a stroke and has garbled speech. What type of diet do
you expect the patient to be prescribed after a speech evaluation?
a. Soft diet
b. Full liquid diet
c. Mechanically altered diet with thin liquids
d. Mechanically altered diet with nectar thick liquids
Correct Answer D
When a patient has a stroke they are at risk for aspiration due to the decrease ability to
swallow. Many times a stroke with affect speech as well the patient's ability to utilize the
swallowing muscles. Generally, when garbled speech is noted in a stroke victim this is a
sign there is a problem with the patient's ability to use their swallowing muscles. A
mechanically altered diet with nectar thick liquid will usually be prescribed. However, a
speech evaluation will determine what is needed.
A patient has a stage 4 pressure ulcer on their sacral area. What type of foods would
the patient most benefit from?
a. Dried beans, eggs, meats
b. Liver, spinach, corn
c. Oats, fruits, and vegetables
d. Peanuts, tomatoes, and cabbage
Correct Answer A
A patient with a stage 4 pressure ulcer needs a high protein diet to promote wound
healing. Dried beans, eggs, and meats are the highest protein foods of the selection.
A patient is suffering from long-term anorexia. What method of delivery would most
likely be used to give adequate nutrition?
a. NG tube
b. G tube
c. IV
d. PO
The answer is C. IV because the client is suffering with long-term anorexia, her nutrition
level is more than likely inadequate.
A patient is receiving total parenteral nutrition (TPN) through a central line. The nurse
checking the patient's glucose levels note that they are within the normal range. What
levels would reflect a normal range?
a. 180-200 mg/dl
b. 100-180 mg/dl
c. 200-220 mg/dl
d. 100-200 mg/dl
The answer is A. 180-220 mg/dl. A normal range for glucose levels in a patient TPN
would be 180-220 mg/dl.
A tube feeding is planned for a patient. The tube will deliver nutrients to all parts of the
GI tract except for which area?
a. duodenum
b. jejunum
c. stomach
d. large intestine
xxx
xxx
The answer is D. large intestine.Tube feedings deliver nutrients directly to the small
intestines and stomach, but not to the large intestine.
xxxx
The nurse is implementing care for the patient who has an intermittent feeding bag. She
needs to add water to the bag. How much water should she add to the bag?
a. 30-60 ml/H20
b. 20-40 ml/H20
c. 60-90 ml/H20
d. 35-55 ml/H20
The answer is A. 30-60 ml/H20.
When maintaining an NG tube for optimal functioning, what is the first thing a nurse
should do?
a. irrigate with H20
b. check placement
c. check patency
d. clamp it
The answer is B. check placement. The first thing to do is to check placement to be sure
that the tube is in correct position to deliver.
A patient is suffering from a broken jaw. Which foods would be most beneficial for this
patient?
A. Carrots, fried chicken, and cereal
B. Soup, pudding, and ice cream
C. Rice, watermelon, and smoked fish
D. Tacos, peanuts, and fresh broccoli
B. A patient with a broken jaw needs foods that require no chewing. Soup, pudding, and
ice cream meet these qualifications.
A patient with anemia would benefit from which diet?
A. Legumes, organ meat, and dark green leafy vegetables
B. Nuts and seeds, fruits, and soy products
C. Vegetables, fish, and pasta
D. Grains, berries, and organic vegetables
A. A patient with anemia needs food high in iron, therefore, legumes, organ meat, and
dark green leafy vegetables are the best choice.
A patient is diagnosed with Congestive Heart Failure and must follow a specific diet.
Which spices are okay for the patient to use daily?
A. Onion Salt & Garlic Powder
B. Ginger & Bay Leaves
C. Sea Salt & Pepper
D. Garlic Sodium & Nutmeg
C. Patients with CHF should avoid excessive sodium. All of the options expect one
contain at least one sodium spice, therefore, Ginger & Bay Leaves are okay to use.
You have a patient who just had a stroke and has garbled speech. What type of diet do
you expect the patient to be prescribed after a speech evaluation?
A. Soft diet
B. Full liquid diet
C. Mechanically altered diet with thin liquids
D. Mechanically altered diet with nectar thick liquids
D . When a patient has a stroke they are at risk for aspiration due to the decrease ability
to swallow. Many times a stroke with affect speech as well the patient's ability to utilize
the swallowing muscles. Generally, when garbled speech is noted in a stroke victim this
is a sign there is a problem with the patient's ability to use their swallowing muscles. A
mechanically altered diet with nectar thick liquid will usually be prescribed. However, a
speech evaluation will determine what is needed.
The nurse is caring for a client with anorexia nervosa who has a nursing diagnosis of
Imbalanced nutrition: less than body requirements related to dysfunctional eating
patterns. Which of the following interventions would be supportive for this client? Select
all that apply.
A. Provide small, frequent meals.
B. Monitor weight gain
C. Allow the client to skip meals until the antidepressant levels are therapeutic
D. Encourage the client to keep a journal
E. Monitor the client during meals and for 1 hour after meals
F. Encourage the client to eat three substantial meals per day.
A,B, D, E. Individuals suffering from anorexia nervosa have a fear of gaining weight and
tend to avoid food altogether. Providing the client with small frequent meals can help
introduce food back into their life without over-doing it at once. Monitoring weight gain
can be beneficial to see progress. Encouraging the client to keep a journal can help
them work through their fears by writing them down, and also allows them to see the
progress they have made if they start to relapse. It is important to monitor the client
while eating so that you are sure they are actually eating the food, and also afterwards
so that they do not regurgitate their food
A patient with anemia would benefit from which diet?
A. Vegetables, fish, and pasta
B. Grains, berries, and organic vegetables
C. Legumes, organ meat, and dark green leafy vegetables
D. Nuts and seeds, fruits, and soy products
Correct Answer: C
When planning nutritional interventions for a healthy 83 year old man, the nurse
recognizes that the factor that is most likely to affect his nutritional status is?
A. living alone on a fixed income
B. changes in cardio function
C. snacking between meals
Correct Answer: A
Based on knowledge of peptic ulcer disease (PUD), the nurse anticipates the presence
of which bacteria when reviewing the laboratory data for a client suspected of having
PUD?
A. Micrococcus
B. Staphylococcus
C. Corynebacteria
D. Helicobacter pylori
Correct Answer: D
Which action should the nurse take initially to verify correct positioning of a newly
placed small-bore feeding tube?
A. Place an order for a radiograph to check position.
B. Confirm the distal mark on the feeding tube after taping.
C. Test the pH
Correct Answer: A
A client with a gastrojejunostomy is beginning to take solid food. Which finding would
lead the nurse to suspect that the client is experiencing dumping syndrome?
a) Slowed heart beat
b) Hyperglycemia
c) Diarrhea
d) Dry skin
C) Diarrhea
Clients with a gastrojejunostomy are at risk for developing the dumping syndrome when
they begin to take solid food. This syndrome produces weakness, dizziness, sweating,
palpitations, abdominal cramps, and diarrhea, which result from the rapid emptying
(dumping) of large amounts of hypertonic chyme (a liquid mass of partly digested food)
into the jejunum. This concentrated solution in the gut draws fluid from the circulating
blood into the intestine, causing hypovolemia. The drop in blood pressure can produce
syncope. As the syndrome progresses, the sudden appearance of carbohydrates in the
jejunum stimulates the pancreas to secrete excessive amounts of insulin, which in turn
causes hypoglycemia.
A nurse is teaching an elderly client about good bowel habits. Which statement by the
client indicates to the nurse that additional teaching is required?
a) "I need to drink 2 to 3 liters of fluids every day."
b) "I should exercise four times per week."
c) "I need to use laxatives regularly to prevent constipation."
d) "I should eat a fiber-rich diet with raw, leafy vegetables, unpeeled fruit, and whole
grain bread."
C) "I need to use laxatives regularly to prevent constipation."
The client requires more teaching if he states that he'll use laxatives regularly to prevent
constipation. The nurse should teach this client to gradually eliminate the use of
laxatives because using laxatives to promote regular bowel movements may have the
opposite effect. A high-fiber diet, ample amounts of fluids, and regular exercise promote
good bowel health.
What kind of feeding should be administered to a client who is at the risk of diarrhea
due to hypertonic feeding solutions?
a) Bolus feeding
b) Intermittent feeding
c) Cyclic feeding
d) Continuous feedings
D) Continuous feedings.
Continuous feedings should be administered to a client who is at the risk of diarrhea
due to hypertonic feeding solutions.
The nurse is assessing a client with a bleeding gastric ulcer. When examining the
client's stool, which of the following characteristics would the nurse be most likely to
find?
a) Green color and texture
b) Black and tarry appearance
c) Clay-like quality
d) Bright red blood in stool
B) Black and tarry appearance
Black and tarry stools (melena) are a sign of bleeding in the upper gastrointestinal (GI)
tract. As the blood moves through the GI system, digestive enzymes turn red blood to
black. Bright red blood in the stool is a sign of lower GI bleeding. Green color and
texture is a distractor for this question. Clay-like stools are a characteristic of biliary
disorders
The nurse is preparing to measure the client's abdominal girth as part of the physical
examination. At which location would the nurse most likely measure?
a) At the lower border of the liver
b) In the right upper quadrant
c) At the umbilicus
d) Just below the last rib
C) At the umbilicus
Measurement of abdominal girth is done at the widest point, which is usually the
umbilicus. The right upper quadrant, lower border of the liver, or just below the last rib
would be inappropriate sites for abdominal girth measurement.

1. A patient receiving parenteral nutrition is administered via the following routes except:
a. Subclavian line.
b. Central Venous Catheter.
c. PICC (Peripherally inserted central catheter) line.
d. PEG tube.
d.

Rational:
Percutaneous endoscopic gastrostomy (PEG tube) is inserted into a person's stomach
through the abdominal wall that is used to provide a means of feeding when oral intake
is not adequate. While Parenteral nutrition bypasses the digestive system by the
administration to the bloodstream.
2. A nurse is monitoring the status of a client's fat emulsion (lipid) infusion and notes
that the infusion is 2 hours delay. The nurse should do which of the following actions?
a. Adjust the infusion rate to catch up over the next hour.
b. Make sure the infusion rate is infusing at the ordered rate.
c. Increase the infusion rate to catch up over the next few hours.
d. Adjust the infusion rate to full blast until the solution is back on time
b.

Rational:
The nurse should maintain the prescribed rate of a fat emulsion even if the infusion's
time consume is behind. Options A, C, and D are incorrect since increasing the rate will
potentially cause a fluid overload.
3. A nurse is preparing to hang the initial bag of the parenteral nutrition (PN) solution via
the central line of a malnourished client. The nurse ensures the availability of which
medical equipment before hanging the solution?
a. Glucometer.
b. Dressing tray.
c. Nebulizer.
d. Infusion pump.
d.

Rational:
The nurse should prepare an infusion pump prior hanging a parenteral solution. The use
of an infusion pump is important to make sure that the solution does not infuse too
quickly or delayed since the parenteral nutrition has a high glucose content. Option A: A
glucometer is also needed since the client's glucose level is monitored every 4 to 6
hours, but it is not an essential item needed. Options B and C are not used before
hanging a PN solution.
4. A nurse is conducting a follow-up home visit to a client who has been discharged with
a parenteral nutrition(PN). Which of the following should the nurse most closely monitor
in this kind of therapy?
a. Blood pressure and temperature.
b. Blood pressure and pulse rate.
c. Height and weight.
d. Temperature and weight.
d.

Rational:
The client's temperature is monitored to identify signs of infection which is one of the
complications of this therapy. While the weight is monitored to detect hypervolemia and
to determine the effectiveness of this nutritional therapy.
5. A nurse is preparing to hang a fat emulsion (lipids) and observes some visible fat
globules at the top of the solution. The nurse ensure to do which of the following
actions?
a. Take another bottle of solution.
b. Runs the bottle solution under a warm water.
c. Rolls the bottle solution gently.
d. Shake the bottle solution vigorously.
a.

Rational:
Fat emulsions are used as dietary supplements for patients who are unable to get
enough fat in their diet, usually because of certain illnesses or recent surgery. The
nurse should examine the bottle of fat emulsion for separation of emulsion into layers or
fat globules or the accumulation of froth. The nurse should not hang a fat emulsion if
any of these observed and should return the solution to the pharmacy.
6. A client is receiving nutrition via parenteral nutrition (PN). A nurse assess the client
for complications of the therapy and assesses the client for which of the following signs
of hyperglycemia?
a. High-grade fever, chills, and decreased urination.
b. Fatigue, increased sweating, and heat intolerance.
c. Coarse dry hair, weakness, and fatigue.
d. Thirst, blurred vision, and diuresis.
d.

Rational:
Signs of hyperglycemia include excessive thirst, fatigue, restlessness, blurred vision,
confusion, weakness, Kussmaul's respirations, diuresis, and coma when hyperglycemia
is severe. Option A are signs of infection. Option B are signs of hyperthyroidism. Option
C are signs of hypothyroidism.
7. A nurse is caring a client who disconnected the tubing of the parenteral nutrition from
the central line catheter. A nurse suspects an occurrence of an air embolism. Which of
the following is an appropriate position for the client in this kind of situation?
a. On the right side, with head higher than the feet.
b. On the right side, with head lower than the feet.
c. On the left side, with the head higher than the feet.
d. On the left side, with head lower than the feet.
d.

Rational:
Air embolism happens when air enters the catheter system when the IV tubing
disconnects. If it is suspected, the client should be placed in a left-side-lying position.
The head should be lower than the feet. This position will lessen the effect of the air
traveling as a bolus to the lungs by trapping it on the right side of the heart.
8. A client is being weaned off from parenteral nutrition (PN) and is given a go-signal to
take a regular diet. The ongoing solution rate has been 120ml/hr. A nurse expects that
which of the following prescriptions regarding the PN solution will accompany the diet
order?
a. Decrease the PN rate to 60ml/hr.
b. Start 0.9% normal saline at 30 ml/hr.
c. Maintain the present infusion rate.
d. Discontinue the PN.
a.

Rationale:
When a client begins eating a regular diet after a period of receiving PN, the PN is
decreased slowly. PN that is terminated abruptly will cause hypoglycemia. Gradually
decreasing the infusion rate allows the client to remain sufficiently nourished during the
transition to a normal diet and prevents an episode of hypoglycemia.
9. A client is receiving parenteral nutrition (PN) in the home setting has a weight gain of
5 lb in 1 week. The nurse next assesses the client to identify the presence of which of
the following?
a. Hypotension.
b. Crackles upon auscultation of the lungs.
c. Thirst.
d. Polyuria.
b.

Rational:
Normally, the weight gain of a client receiving PN is about 1-2 pound a week. A weight
gain of 5 pounds over a week indicates a client is experiencing fluid retention that can
result to hypervolemia. Signs of hypervolemia includes weight gain more than desired,
headache, jugular vein distention, bounding pulse, and crackles on lung auscultation.
Option A: Hypertension, not hypotension is expected. Options C and D are associated
with hyperglycemia.
10. A nurse is making initial rounds at the beginning of the shift and notice that the
parenteral nutrition (PN) bag of an assigned client is empty. Which of the following
solutions readily available on the nursing unit should the nurse hang until another PN
solution is mixed and delivered to the nursing unit?
a. 10% dextrose in water.
b. 5% dextrose in water.
c. 5% dextrose in normal saline.
d. 5% dextrose in lactated Ringer solution.
a.

Rational:
The client is at risk of hypoglycemia. Hence the nurse will hang a solution that has the
highest amount of glucose until the new parenteral nutrition solution becomes readily
available.
11. A nurse is caring for a group of clients on a medical-surgical nursing unit. The nurse
recognizes that which of the following clients would be the least likely candidate for
parenteral nutrition?
a. A 55-year-old with persistent nausea and vomiting from chemotherapy.
b. A 44-year old client with ulcerative colitis.
c. A 59-year old client who had an appendectomy.
d. A 25-year old client with a Hirschprung's Disease.
c.

Rational:
The client with an appendectomy is not a candidate because this client would resume a
regular diet within a few days following the surgery. Options A, B, and D are incorrect
because parenteral nutrition is indicated in these clients since their gastrointestinal
tracts are not functional or who cannot take in a diet enterally for extended periods.
12. A client is receiving parenteral nutrition (PN) suddenly is having a fever. A nurse
notifies the physician and the physician initially prescribes that the solution and tubing
be changed. The nurse should do which of the following with the discontinued
materials?
a. Send them to the laboratory for culture.
b. Save them for a return to the manufacturer.
c. Return them to the hospital pharmacy.
d. Discard them in the unit trash.
a.

Rational:
When the client who is receiving PN has a high temperature, a catheter-related infection
should be suspected. The solution and tubing should be changed, and the discontinued
materials should be cultured for an infectious organism.
13. A nurse is changing the central line dressing of a client receiving parenteral nutrition
(PN) and notes that there are redness and drainage at the insertion site. The nurse next
assesses which of the following?
a. Time of last dressing change.
b. Allergy.
c. Client's temperature.
d. Expiration date.
c.

Rational:
Redness at the catheter insertion site is a possible sign of infection. The nurse would
next assess for other signs of infection. Of the options given, the temperature is the next
item to assess.
14. A client receiving parenteral nutrition (PN) complains of a headache. A nurse notes
that the client has a bounding pulse, jugular distension, and weight gain greater than
desired. The nurse determines that the client is experiencing which complication of PN
therapy?
a. Air embolism.
b. Hypervolemia.
c. Hyperglycemia.
d. Sepsis.
b.

Rational:
Hypervolemia is a critical situation and occurs from excessive fluid administration or
administration of fluid too rapidly. Clients with cardiac, renal, or hepatic dysfunction are
also at risk. The client's symptoms presented in the question are consistent with
hypervolemia. The increased intravascular volume increases the blood pressure
whereas the pulse rate increases as the heart tries to pump the extra fluid volume. The
increased volume also causes neck vein distention and shifting of fluid into the alveoli,
resulting in lung crackles.
15. A nurse is preparing to change the parenteral nutrition (PN) solution bag and tubing.
The client's central venous line is located in the right subclavian vein. The nurse ask the
client to take which essential action during the tube change?
a. Turn the head to the right.
b. Inhale deeply, hold it, and bear down.
c. Breathe normally.
d. Exhale slowly and evenly.
b.
Rational:
The client should be asked to perform the Valsalva maneuver during tubing changes.
This helps avoid air embolism during tube changes. The nurse asks the client to take a
deep breath, hold it, and bear down. Option A is incorrect because if the intravenous
line is on the right, the client turns his or head to the left. This position increases
intrathoracic pressure. Options C and D can cause the potential for an air embolism
during the tube change.
16. A nurse observes the client receiving fat emulsions is having hives. A nurse reviews
the client's history and note in which of the following may cause about by the complaint
of the client?
a. Allergy to an egg.
b. Allergy to peanut.
c. Allergy to shellfish.
d. Allergy to corn.
a.

Rational:
Fat emulsions (lipids) contain egg yolk phospholipids and should not be given to clients
with egg allergies.
17. A client receiving parenteral nutrition (PN) complains of shortness of breath and
shoulder pain. A nurse notes that the client has an increased pulse rate. The nurse
determines that the client is experiencing which complication of PN therapy?
a. Air embolism.
b. Hypervolemia.
c. Hyperglycemia.
d. Pneumothorax.
d.

Rational:
Pneumothorax might happen during a parenteral therapy due to inexact catheter
placement. In order to prevent this, the nurse obtains a chest x-ray after insertion of the
catheter to ensure proper catheter placement.
18. A nurse is caring for a combative client who is ordered to have a nutritional therapy
using parenteral nutrition (PN). The nurse should plan which of the following measures
to prevent the client from injury?
a. Monitor blood glucose twice a day.
b. Instruct the relative to stay with the nurse.
c. Measure 24-hour intake and output.
d. Secure all connections in the parenteral system.
d.

Rational:
The nurse should plan to secure all connections in the tubing. This will prevent the client
from pulling the connections apart.
19. Nurse Spencer is caring for an anorexic client who is having total parenteral solution
for the first time. Which of the following assessments requires the most immediate
attention?
a. Dry sticky mouth.
b. Temperature of 100° Fahrenheit.
c. Blood glucose of 210 mg/dl.
d. Fasting blood sugar of 98 mg/dl.
c.

Rational:
Total parenteral nutrition formula contains dextrose range from 5% to 70%. A blood
glucose level of 210mg/dl is considered high.
20. Nurse Russell is preparing to give a total parenteral nutrition using a central line.
Place the following steps for administration in the correct order?
1) Connect the tubing to the central line.
2) Regulate the electric infusion pump at the ordered rate.
3) Maintain aseptic technique when handling the injection cap.
4) Check the solution for cloudiness, particles, or a change in color.
5) Prime the IV tubing through an infusion pump.
6) Select and flush the correct tubing and filter.
a. 4, 3, 5, 6, 1, and 2.
b. 6, 4, 5, 1, 3, and 2.
c. 4, 6, 5, 3, 1, and 2.
d. 3, 4, 6, 1, 5, and 2.
c.

A client is being weaned from parenteral nutrition (PN) and is expected to begin taking
solid food today. The ongoing solution rate has been 100 ml/hour. The nurse anticipated
that which prescription regarding PN will accompany the diet prescription?
1. Discontinue the PN
2. Decrease PN rate to 50 mL/hour
3. Start 0.9% normal saline at 25 mL/hour
4. Continue current infusion rate prescription for PN
2. Rationale- When a client begins eating a regular diet after a period of receiving PN,
the PN is decreased gradually. PN that is discontinued abruptly can cause
hypoglycemia. Clients often have anorexia after beng without food for some time, and
the digestive tract also is not used to producing the digestive enzymes that will be
needed. Gradually decreasing the infusion rate allows the client to remain adequately
nourished during the transition to a normal diet and prevents the occurrence of
hypoglycemia. Even before clients are started on a solid diet, they are given clear
liquids followed by full liquids to further ease the transition. A solution of normal saline
does not provide the glucose needed during the transition of discontinuing the PN and
could cause the client to experience hypoglycemia.
The nurse is preparing to change the parenteral nutrition (PN) solution bag and tubing.
The client's central venous line is located in the right subclavian vein. The nurse asks
the client to take which essential action during the tubing change?
1. Breath normally
2. Turn the head to the right
3. Exhale slowly and evenly
4. Take a deep breath, hold it, and bear down.
4. Rationale- The client should be asked to perform the Valsalva maneuver during
tubing changes. This helps avoid air embolism during tubing changes. The nurse asks
the client to take a deep breath, hold it, and bear down. If the intravenous line is on the
right, the client turns is or her head to the left. This position increases intrathoracic
pressure. Breathing normally and exhaling slowly and evenly are inappropriate and
could enhance the potential for an air embolism during the tubing change.
A client with parenteral nutrition (PN) infusing has disconnected the tubing from the
central line catheter. The nurse assesses the client and suspects an air embolism. The
nurse should immediately place the client in which position?
1. On the left side, with the head lower than the feet
2. On the left side, with the head higher than the feet
3. On the right side, with the head lower than the feet
4. On the right side, with the head higher than the feet
1. Rationale- Air embolism occurs when air enters the catheter system, such as when
the system is opened for intravenous (IV) tubing changes or when the IV tubing
disconnects. Air embolism is a critical situation; if it is suspected, the client should be
placed in a left side-lying position. The head should be lower than the feet. This position
is used to minimize the effect of the air traveling as a bolus to the lungs by trapping it in
the right side of the heart. The positions in the remaining options are inappropriate if an
air embolism is suspected.
Which nursing action is essential prior to initiating a new prescription for 500 mL of fat
emulsion (lipids) to infuse at 50 mL/hour?
1. Ensure that the client does not have diabetes
2. Determine whether the client has an allergy to eggs
3. Add regular insulin to the fat emulsion, using aseptic technique
4. Contact the health care provider (HCP) to have a central line inserted for fat emulsion
infusion
2. Rationale-The client beginning infusions of fat emulsions must be first assessed for
known allergies to eggs to prevent anaphylaxis. Egg yolk is a component of the solution
and provides emulsification. The remaining options are unnecessary and are not related
to the administration of fat emulsion.
A client is receiving parenteral nutrition (PN). The nurse monitors the client for
complications of the therapy and should assess the client for which manifestations of
hyperglycemia?
1. Fever, weak pulse, and thirst
2. Nausea, vomiting, and oliguria
3. Sweating, chills, and abdominal pain
4. Weakness, thirst, and increased urine output
4. Rationale-The high glucose concentration in PN places the client at risk for
hyperglycemia. Signs of hyperglycemia include excessive thirst, fatigue, restlessness,
confusion, weakness, Kussmaul's respirations, diuresis, and coma when hyperglycemia
is severe. If the client has these symptoms, the blood glucose level should be checked
immediately. The remaining options do not identify signs specific to hyperglycemia.
The nurse is changing the central line dressing of a client receiving parenteral nutrition
(PN) and notes that the catheter insertion site appears reddened. The nurse should next
assess which item?
1. Client's temperature
2. Expiration of the bag
3. Time of last dressing change
4. Tightness of tubing connections
1. Rationale- Redness at the catheter insertion site is a possible indication of infection.
The nurse would next assess for other signs of infection. Of the options given, the
temperature is the next item to assess. The tightness of tubing connection should be
assessed each time the PN is checked; loose connections would result in leakage, not
skin redness. The expiration date on the bag is a viable option, but this also should be
checked at the time the solution is hung and with each shift change. The time of the last
dressing change should be checked with each shift change.
The nurse is preparing to hang fat emulsion (lipids) and notes that fat globules are
visible at the top of the solution. The nurse should take which action?
1. Rolls the bottle of solution gently
2. Obtains a different bottle of solution
3. Shakes the bottle of solution vigorously
4. Runs the bottle of solution under warm water.
2. Rationale- Fat emulsion (lipids) is a white, opaque solution administered
intravenously during parenteral nutrition therapy to prevent fatty acid deficiency. The
nurse should examine the bottle of fat emulsion for separation of emulsion into layers of
fat globules or for the accumulation of froth. The nurse should not hang a fat emulsion if
any of these are observed and should return the solution to the pharmacy. Therefore
the remaining options are inappropriate actions.
A client receiving parenteral nutrition (PN) suddenly develops a fever. The nurse notifies
the health care provider (HCP) and the HCP initially prescribes that the solution and
tubing be changed. What should the nurse do with the discontinued materials?
1. Discard them in the unit trash
2. Return them to the hospital pharmacy
3. Send them to the laboratory for culture
4. Save them for return to the manufacturer
3. Rationale- When the client who is receiving PN develops a fever, a catheter-related
infection should be suspected. The solution and tubing should be changed, and the
discontinued materials should be cultured for infectious organisms. The other options
are incorrect. Because culture for infectious organisms is necessary, the discontinued
materials are not discarded or returned to the pharmacy or manufacturer.
A client has been discharged to home on parenteral nutrition (PN). With each visit, the
home care nurse should assess which parameter most closely in monitoring this
therapy?
1. Pulse and weight
2. Temperature and weight
3. Pulse and blood pressure
4. Temperature and blood pressure
2. Rationale-The client receiving PN at home should have her or his temperature
monitored as a means of detecting infection, which is a potential complication of this
therapy. An infection also could result in sepsis because the catheter is in a blood
vessel. The client's weight is monitored as a measure of the effectiveness of this
nutritional therapy and to detect hypervolemia. The pulse and blood pressure are
important parameters to assess, but they do not relate specifically to the effects of PN.
The nurse is caring for a group of adult clients on an acute care medical-surgical
nursing unit. The nurse understands that which client would be the least likely candidate
for parenteral nutrition (PN)?
1. A 66 year-old client with extensive burns
2. A 42 year-old client who has had an open cholecystectomy
3. A 27 year-old client with severe exacerbation of Crohn's disease
4. A 35 year-old client with persistant nausea and vomiting from chemotherapy
2. Rationale- Parenteral nutrition is indicated in clients whose gastrointestinal tracts are
not functional or must be rested, cannot take in a diet enterally for extended periods, or
have increased metabolic need. Examples of these conditions include those clients with
burns, exacerbation of Chron's disease, and persistent nausea and vomiting due to
chemotherapy. Other clients would be those who have had extensive surgery, have
multiple fractures, are septic, or have advanced cancer or acquired immunodeficiency
syndrome. The client with the open cholecystectomy is not a candidate because this
client would resume a regular diet within a few days following surgery.
The nurse is preparing to hang the first bag of parenteral nutrition (PN) solution via the
central line of an assigned client. The nurse should obtain which most essential piece of
equipment before hanging the solution?
1. Urine test strips
2. Blood glucose meter
3. Electronic infusion pump
4. Noninvasive blood pressure monitor
3. Rationale- The nurse obtains an electronic infusion pump before hanging a PN
solution. Because of the high glucose content, use of an infusion pump is necessary to
ensure that the solution does not infuse too rapidly or fall behind. Because the client's
blood glucose level is monitored every 4 to 6 hours during administration of PN, a blood
glucose meter also will be needed, but this is not the most essential item needed before
hanging the solution. Urine test strips (to measure glucose) rarely are used because of
the advent of blood glucose monitoring. Although the blood pressure will be monitored,
a noninvasive blood pressure monitor is not the most essential piece of equipment
needed for this procedure.
The nurse is making initial rounds at the beginning of the shift and notes that the
parenteral nutrition (PN) bag of an assigned client is empty. Which solution readily
available on the nursing unit should the nurse hang until another PN solution is mixed
and delivered to the nursing unit?
1. 5% dextrose in water
2. 10% dextrose in water
3. 5% dextrose in Ringer's lactate
4. 5% dextrose in 0.9% sodium chloride
2. Rationale- The client is at risk for hypoglycemia; therefore the solution containing the
highest amount of glucose should be hung until the new PN solution becomes available.
Because PN solutions contain high glucose concentrations, the 10% dextrose in water
solution is the best of the choices presented. The solution selected should be one that
minimizes the risk of hypoglcemia. The remaining options will not be as effective in
minimizing the risk of hypoglycemia.

The nurse monitoring the status of a client's fat emulsion (lipid) infusion and notes that
the infusion is 1 hour behind. Which action should the nurse take?
1. Adjust the infusion rate to catch up over the next hour
2. Increase the infusion rate to catch up over the next two hours
3. Ensure that the fat emulsion infusion rate is infusing at the prescribed rate
4. Adjust the infusion rate to run wide open until the solution is back on time
3. Rationale- The nurse should not increase the rate of a fat emulsion to make up the
difference if the infusion timing falls behind. Doing so could place the client at risk for fat
overload. In addition, increasing the rate suddenly can cause fluid overload. The same
principle (not increasing the rate) applies to PN or any intravenous (IV) infusion.
Therefore the remaining options are incorrect.
A client receiving parenteral nutrition (PN) in the home setting has a weight gain of 5 lb
in 1 week. The nurse should next assess the client for the presence of which condition?
1. Thirst
2. Polyuria
3. Decreased blood pressure
4. Crackles on auscultation of the lungs
4. Rationale- Optimal weight gain when the client is receiving PN is 1 to 2lb/week. The
client who has a weight gain of 5lb/week while receiving PN is likely to have fluid
retention. This can result in hypervolemia. Signs of hypervolemia include increased
blood pressure, crackles on lung auscultation, a bounding pulse, jugular vein distention,
headache, and weight gain more than desired. Thirst and polyuria are associated with
hyperglycemia. A decreased blood pressure is likely to be noted in deficient fluid
volume.
The nurse is caring for a restless client who is beginning nutritional therapy with
parenteral nutrition (PN). The nurse should plan to ensure that which action is taken to
prevent the client from sustaining injury?
1. Calculate daily intake and output
2. Monitor the temperature once daily
3. Secure all connections in the PN system
4. Monitor blood glucose levels every 12 hours
3. Rationale- The nurse should plan to secure all connection tubing (tape is used per
agency protocol). This helps prevent the restless client from pulling the connections
accidentally. The nurse should also monitor intake and output, but this does not relate
specifically to a risk for injury presented in the question. In addition, the client's
temperature and blood glucose levels are monitored more frequently that the time
frames identified in the options to detect signs of infection and hyperglycemia,
respectively.
A client receiving parenteral nutrition (PN) complains of a headache. The nurse notes
that the client has an increased blood pressure, bounding pulse, jugular vein distention,
and crackles bilaterally. The nurse determines that the client is experiencing which
complications of PN therapy?
1. Sepsis
2. Air embolism
3. Hypervolemia
4. Hyperglycemia
3. Rationale- Hypervolemia is a critical situation and occurs from excessive fluid
administration or administration of fluid too rapidly. Clients with cardiac, renal, or hepatic
dysfunction are also at increased risk. The client's signs and symptoms presented in the
question are consistent with hypervolemia. The increased intravascular volume
increases the blood pressure, whereas the pulse rate increases as the heart tries to
pump the extra fluid volume. The increased volume also causes neck vein distention
and shifting of fluid into the alveoli, resulting in lung crackles. The signs and symptoms
presented in the question do not indicate sepsis, air embolism, or hyperglycemia.

A client is receiving nutrition via parenteral nutrition (PN). A nurse assess the client for complications of the
therapy and assesses the client for which of the following signs of hyperglycemia?

A. High-grade fever. chills. and decreased urination.

B. Fatigue. increased sweating. and heat intolerance.
C. Coarse dry hair. weakness. and fatigue.
D. Thirst. blurred vision. and diuresis.
Incorrect Difficulty: Hard44% got this correct
2) A nurse is caring a client who disconnected the tubing of the parenteral nutrition from the central line
catheter. A nurse suspects an occurrence of an air embolism. Which of the following is an appropriate
position for the client in this kind of situation?

A. On the right side. with head higher than the feet.

B. On the right side. with head lower than the feet.
C. On the left side. with the head higher than the feet.
D. On the left side. with head lower than the feet.
Incorrect Difficulty: Easy59% got this correct
3) A client is being weaned off from parenteral nutrition (PN) and is given a go-signal to take a regular diet. The
ongoing solution rate has been 120ml/hr. A nurse expects that which of the following prescriptions regarding
the PN solution will accompany the diet order?

A. Decrease the PN rate to 60ml/hr.

B. Start 0.9% normal saline at 30 ml/hr.
C. Maintain the present infusion rate.
D. Discontinue the PN.
Incorrect Difficulty: Easy77% got this correct
4) A client is receiving parenteral nutrition (PN) in the home setting has a weight gain of 5 lb in 1 week. The
nurse next assesses the client to identify the presence of which of the following?
 A. Hypotension.
B. Crackles upon auscultation of the lungs.
C. Thirst.
D. Polyuria.
Incorrect Difficulty: Hard48% got this correct
5) A nurse is making initial rounds at the beginning of the shift and notice that the parenteral nutrition (PN) bag
of an assigned client is empty. Which of the following solutions readily available on the nursing unit should
the nurse hang until another PN solution is mixed and delivered to the nursing unit?

A. 10% dextrose in water.

B. 5% dextrose in water.
C. 5% dextrose in normal saline.
D. 5% dextrose in lactated Ringer solution.
Incorrect Difficulty: Easy66% got this correct
6) A client is receiving parenteral nutrition (PN) suddenly is having a fever. A nurse notifies the physician and
the physician initially prescribes that the solution and tubing be changed. The nurse should do which of the
following with the discontinued materials?

A. Send them to the laboratory for culture.

B. Save them for a return to the manufacturer.
C. Return them to the hospital pharmacy.
D. Discard them in the unit trash.
Incorrect Difficulty: Easy65% got this correct
7) A nurse is changing the central line dressing of a client receiving parenteral nutrition (PN) and notes that
there are redness and drainage at the insertion site. The nurse next assesses which of the following?

A. Time of last dressing change.

B. Allergy.
C. Client’s temperature.
D. Expiration date.
Incorrect Difficulty: Easy62% got this correct
8) A nurse is preparing to change the parenteral nutrition (PN) solution bag and tubing. The client's central
venous line is located in the right subclavian vein. The nurse ask the client to take which essential action
during the tube change?

A. Turn the head to the right.

B. Inhale deeply. hold it. and bear down.
C. Breathe normally.
D. Exhale slowly and evenly.