Bernales, Jan Lianne E.

NCM 116a Medical-Surgical Nursing

BSN III-B2 Module #2; Activity 2

TOPIC: ACUTE AND CHRONIC ALTERATION / PROBLEMS IN NUTRITION

1. 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. 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 Hirschsprung’s Disease.

RATIONALE:
=The client with an appendectomy is not a candidate because this client would resume a regular
diet within a few days following the surgery. The purpose of administering parenteral nutrition is
indicated for those clients who have gastrointestinal tracts that are not functional or who cannot
take in a diet enterally for extended periods.

2. Potential TPN-associated metabolic complications include which of the following?

A. Sepsis, glucose intolerance, and electrolyte imbalances
B. Cachexia, glucose intolerance, and essential fatty acid deficiency
C. Lipoid nephrosis, glucose intolerance, and electrolyte imbalances
D. Glucose intolerance, electrolyte imbalances, and essential fatty acid deficiency.

RATIONALE:
= Metabolic complications are more likely to occur in the absence of a nutrition support team, in
patients with severe malnutrition, organ dysfunction, or when physicians do not perceive
parenteral nutrition as a powerful adjunct therapy and instead use it as urgent and ‘‘life-saving’’.
Failure to administer a balanced and sufficient amount of macro and micronutrients may lead, in
the short or long-term, to deficiencies. Nutrient requirements of patients are often difficult to
define precisely; age (infants, children, elderly), disease severity and poor nutritional status are
all risk factors. In long-term PN, any deficiency of essential nutrients is detrimental; the most
commonly cited relate to: linoleic acid, zinc, copper, chromium, selenium, fat or water-soluble
vitamins.

3. You just inserted a Nasogastric tube. Which of the following is not a correct way to
check correct placement of the tube?*
A. Following the MD order for an X-ray to confirm placement
B. Obtaining a sample of GI contents through the tube by aspirating
C. Administering a 100cc Water flush and assessing for patient coughing
D. Checking pH of GI contents to be at 1 to 3.5

RATIONALE:
=Flushing water into the tube without confirming the placement will result to aspiration. There
are other ways to confirm placement without the risk of hurting the patient like, injecting air and
auscultating to listen would be a possible answer.
4. 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.

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.

5. A nurse is inserting a nasogastric tube in an adult male client. During the procedure, the
client begins to cough and has difficulty breathing. Which of the following is the
appropriate nursing action?
A. Quickly insert the tube
B. Notify the physician immediately
C. Remove the tube and reinsert when the respiratory distress subsides
D. Pull back on the tube and wait until the respiratory distress subsides

RATIONALE:
= During the insertion of a nasogastric tube, if the client experiences difficulty breathing or any
respiratory distress, withdraw the tube to stop the tube advancement, and wait until the distress
subsides. Quickly inserting the tube is not an appropriate action because, in this situation, it may
be likely that the tube has entered the bronchus.

6. 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.

RATIONALE:
= Following the cardinal signs of inflammation, Redness is caused by the dilation of small blood
vessels in the area of injury. So, the nurse would next assess for other signs of infection like the
client’s temperature. Fever is brought about by chemical mediators of inflammation and
contributes to the rise in temperature at the injury.
7. Nurse Spencer 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?
A. Dry sticky mouth.
B. Temperature of 100° Fahrenheit.
C. Blood glucose of 210 mg/dl.
D. Fasting blood sugar of 98 mg/dl.

RATIONALE:
= Total parenteral nutrition formula contains dextrose range from 5% to 70%. A blood glucose
level of 210mg/dl is considered high.

8. A client 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?
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.

RATIONALE:
= Signs of hyperglycemia include excessive thirst, fatigue, restlessness, blurred vision,
confusion, weakness, Kussmaul's respirations, diuresis, and coma when hyperglycemia is severe.

9. 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

RATIONALE:
= 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.

10. You just inserted a Nasogastric tube. Which of the following is not a correct way to
check correct placement of the tube?
A. Following the MD order for an X-ray to confirm placement
B. Obtaining a sample of GI contents through the tube by aspirating
C. Administering a 100cc Water flush and assessing for patient coughing
D. Checking pH of GI contents to be at 1 to 3.5

RATIONALE:
= Flushing water into the tube without confirming the placement will result to aspiration. There
are other ways to confirm placement without the risk of hurting the patient like, injecting air and
auscultating to listen would be a possible answer.