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High Acuity Nursing 5th Edition Wagner Johnson Hardin-Pierce Test Bank

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High Acuity Nursing 5th Edition Wagner Johnson Hardin-Pierce Test Bank

ISBN-13: 978-0135049266

ISBN-10: 0135049261

 

 

Description

High Acuity Nursing 5th Edition Wagner Johnson Hardin-Pierce Test Bank

ISBN-13: 978-0135049266

ISBN-10: 0135049261

 

 

 

 

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Free Nursing Test Questions:

 

Wagner

 

Module 33 – Alterations in Metabolism

 

Learning Objectives

 

33-1. Explain how the physiological stressors of illness and injury affect nutritional needs.

 

33-2. Describe the major nutritional alterations associated with specific disease states.

 

33-3. Describe enteral nutrition, including the benefits and potential complications, rationale for gastric versus postpyloric feeding, and barriers to providing optimal enteral nutrition to the high-acuity patient.

 

33-4. Discuss the parenteral methods used to provide nutrition for the high-acuity patient, including potential complications.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LO: 33-1. Explain how the physiological stressors of illness and injury affect nutritional needs.

 

  1. While turning a patient in bed, the nurse notes a considerable amount of the patient’s

hair is on the pillow. The nurse realizes this could indicate which of the following

nutritional disorders?

  1. protein-calorie malnutrition
  2. Marasmus
  3. Kwashiorkor
  4. obesity

 

Answer: 1

 

Rationale: Clinical signs of protein-protein malnutrition include skin breakdown, poor wound healing, and surgical dehiscence. Hair is easily plucked, and hair remnants are often noted on the patient’s pillowcase and/or sheets. Marasmus is a severe cachetic process where all available fat stores have been depleted from calorie deficiency and is not associated with hair loss. Kwashiorkor is a condition that occurs in the presence of protein deficiency but the patient is receiving adequate calories for survival; it is not associated with hair loss. Obesity is a condition of over-nutrition and is not characterized by hair loss.

 

Cognitive Level: Analyzing

 

Nursing Process: Assessment

 

Client Need: Physiological Integrity

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LO: 33-1. Explain how the physiological stressors of illness and injury affect nutritional needs.

 

  1. A patient with a BMI of 32 is in the intensive care unit recovering from surgery to

repair an abdominal aortic aneurysm. When planning for this patient’s nutritional

needs, which of the following should the nurse consider?

  1. begin a weight reduction program immediately
  2. meet the patient’s current nutritional needs to optimize outcomes
  3. introduce periods of fasting so the patient will get used to less food intake
  4. maintain on intravenous fluids and clear liquids to assist the fat burning process

 

Answer: 2

 

Rationale: Implementation of a low-calorie diet during acute illness may accelerate loss of lean body mass, which is inappropriate in an acutely ill patient. The obese high acuity patient has a higher BMI than a non-obese patient and will have higher resting energy expenditure. During acute illness it is crucial to meet the elevated nutrient needs of obese patients to optimize outcomes. The other choices are inappropriate because they would not meet the patient’s current nutritional needs and could hinder the healing process.

 

Cognitive Level: Applying

 

Nursing Process: Planning

 

Client Need: Physiological Integrity

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LO: 33-1. Explain how the physiological stressors of illness and injury affect nutritional needs.

 

  1. A patient admitted for a gunshot wound to the leg and multiple abdominal stab

wounds is admitted to the intensive care unit after surgery. Which of the following

might the nurse observe that would impact this patient’s nutritional needs at this time?

  1. increase in body temperature
  2. respiratory rate of 22 per minute and regular
  3. elevated blood glucose level
  4. blood pressure 130/84 mm Hg

 

Answer: 3

 

Rationale: The first 24 hours after a body injury, the body responds with a drop in body temperature and an increase in mobilization of carbohydrates and lipids. Glucose production increases in efforts to support wound healing. The body also responds by decreasing the amount of insulin produced. Because of these bodily responses, the nurse will most likely observe an elevated blood glucose level which will impact the patient’s nutritional needs at this time. Body temperature will respond with dropping and not increasing. The respiratory rate of 22 per minute and regular will not negatively impact this patient’s nutritional needs. A blood pressure of 130/84 mm Hg might be a normal blood pressure for the patient and will not necessarily impact this patient’s nutritional needs.

 

Cognitive Level: Applying

 

Nursing Process: Assessment

 

Client Need: Physiological Integrity

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LO: 33-1. Explain how the physiological stressors of illness and injury affect nutritional needs.

 

  1. A patient, recovering from multiple traumas caused from a motor vehicle accident, has

been in the intensive care unit for 4 days. Which of the following clinical findings

would suggest to the nurse that the patient is experiencing a metabolic stress response?

  1. respiratory rate 18 per minute
  2. insulin ineffective to reduce rising blood glucose level
  3. heart rate 88 and regular
  4. urine output 50 cc/hour

 

Answer: 2

 

Rationale: The flow phase of the metabolic stress response peaks in 3 to 4 days after the initial physiological injury. Evidence of the flow phase includes tachycardia, tachypnea, and increased cardiac output. Hyperglycemia is seen after injury because glucose production is needed to meet the body’s demands. Catecholamines released at the time of injury add to the rising glucose level. Because of this, the administration of insulin in efforts to reduce the blood glucose level may be ineffective at this time. The respiratory rate of 18 per minute is a normal rate and not tachypnea. The heart rate of 88 beats per minute is a normal rate and not tachycardia. A urine output of 50 cc/hour is a normal urine output.

 

Cognitive Level: Analyzing

 

Nursing Process: Assessment

 

Client Need: Physiological Integrity

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LO: 33-1. Explain how the physiological stressors of illness and injury affect nutritional needs.

 

  1. The nurse is planning a refeeding program for a patient diagnosed with cachexia from

AIDS. Which of the following would be the best approach to take with this patient?

  1. encourage the patient to ingest as much food as possible during each meal
  2. plan to have the patient ingest the established goal of calories within 2 days
  3. limit the patient’s intake of fluids so to encourage a normal appetite
  4. increase calories daily at the rate of 20 kcal/kg of the patient’s body weight

 

Answer: 4

 

Rationale: The patient with cachexia from AIDS is at risk for developing refeeding syndrome. In efforts to reduce this risk, the patient’s calories should be increased daily at the rate of 20 kcal/kg of body weight. If the patient ingests as much food as possible during each meal, the risk of refeeding syndrome will increase. The increase in calories to the established goal may need to occur over a week and not within 2 days. Restriction of fluids is not indicated, will not necessarily stimulate a normal appetite, and may place the patient at risk for fluid volume deficit.

 

Cognitive Level: Applying

 

Nursing Process: Planning

 

Client Need: Physiological Integrity

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LO: 33-2. Describe the major nutritional alterations associated with specific disease states.

 

  1. The nurse is caring for a patient with a history of hypercapnea. Which of the following

should the nurse include when planning for this patient’s nutritional needs?

  1. monitor carbohydrate intake to reduce body carbon dioxide levels
  2. limit protein
  3. encourage fat intake
  4. minimize vitamin supplements

 

Answer: 1

 

Rationale: Limiting the carbohydrate intake in a patient with a history of hypercapnea would be beneficial in efforts to reduce the body’s carbon dioxide load. The patient’s protein should not be limited but rather calculated to meet the patient’s needs. Fat intake should not be encouraged. Vitamin supplements should be provided according to the patient’s needs and not minimized unless necessary.

 

Cognitive Level: Applying

 

Nursing Process: Planning

 

Client Need: Physiological Integrity

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LO: 33-2. Describe the major nutritional alterations associated with specific disease states.

  1. The nurse is caring for a patient diagnosed with chronic renal failure and being treated

with hemodialysis who weighs 100 kg. Which of the following would be an

appropriate intake of protein for this patient?

  1. 60 gm per day
  2. 240 gm per day
  3. 120 gm per day
  4. 100 gm per day

 

Answer: 3

 

Rationale: The patient with renal failure receiving maintenance hemodialysis would benefit from receiving a protein intake of 1.2 g/kg per day. The patient weighs 100 kg and therefore would need a daily intake of 120 gm of protein per day. The other choices are incorrect calculations.

 

Cognitive Level: Applying

 

Nursing Process: Implementation

 

Client Need: Physiological Integrity

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LO: 33-2. Describe the major nutritional alterations associated with specific disease states.

 

  1. A patient, being treated for multiple injuries in the intensive care unit, had been NPO

for several days. While attempting to provide oral nourishment, the patient complains

of early satiety, has a large emesis, and develops a fever. These assessment findings

could indicate which of the following to the nurse?

  1. fluid intolerance
  2. electrolyte imbalance
  3. gastric ulcer
  4. gut failure

 

Answer: 4

 

Rationale: During periods of high stress, the body will shunt blood to the organs to maintain maximum functioning. When this occurs, the gastrointestinal tract could develop ischemia and atrophy. The introduction of food or fluids at this time could cause the patient to vomit and have complaints of early satiety. With an ischemic gut, the patient is prone to developing bacterial translocation which means bacteria enter the general circulation from the gastrointestinal tract. This is a major cause of sepsis with the body response as an increase in temperature. The patient’s inability to tolerate fluids after being NPO would not indicate fluid intolerance, electrolyte imbalance, or a gastric ulcer.

 

Cognitive Level: Analyzing

 

Nursing Process: Assessment

 

Client Need: Physiological Integrity

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LO: 33-2. Describe the major nutritional alterations associated with specific disease states.

 

  1. The nurse is caring for a patient who sustained burns of 40% of the total body surface

area. Which of the following would be indicated to meet this patient’s nutritional

needs?

  1. nutritional assessment and supply with high calorie, high protein supplements
  2. provide high dose therapy of vitamins C and B
  3. supply with high fat and high carbohydrate supplements
  4. supply with balanced nutrients to meet current body weight needs

 

Answer: 1

 

Rationale: The patient recovering from a burn injury of 40% of the total body surface should have a complete nutritional assessment and then be supplied with high calorie, high protein supplements to meet the body’s hypermetabolic and healing needs. Research does not support the use of specific supplements to high dose therapy of vitamins C and B and would not be appropriate. The patient needs high protein supplements as well as a sufficient number of calories from carbohydrates and fats to meet the body’s needs. Because of the hypermetabolic status of the patient, the patient needs more calories than those needed to meet current body weight needs.

Cognitive Level: Analyzing

 

Nursing Process: Planning

 

Client Need: Physiological Integrity

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LO: 33-2. Describe the major nutritional alterations associated with specific disease states.

 

  1. The nurse is caring for a patient who is comatose after a traumatic brain injury. Which

of the following would be important for the nurse to include when planning for this

patient’s nutritional needs?

  1. limit protein intake to encourage the body to utilize circulating blood glucose
  2. ensure adequate protein intake to maintain a positive nitrogen balance
  3. plan to implement hyperalimentation as soon as possible
  4. provide adequate calories in the form of carbohydrates and fats

 

Answer: 2

 

Rationale: In the patient with a traumatic brain injury, providing adequate energy and protein for a positive nitrogen balance is paramount to successful treatment, and aggressive nutrition support is recommended. The patient should not have a restricted intake of protein since this would cause a negative nitrogen balance and a poor outcome. Enteral feeding and hyperalimentation is the preferred method of choice for a patient recovering from a traumatic brain injury. Calories should be provided to support all nutritional needs and not focus on carbohydrates and fats. Restricting protein can lead to a negative nitrogen balance and a poor outcome.

 

Cognitive Level: Applying

 

Nursing Process: Planning

 

Client Need: Physiological Integrity

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LO: 33-3. Describe enteral nutrition, including the benefits and potential complications, rationale for gastric versus postpyloric feeding, and barriers to providing optimal enteral nutrition to the high-acuity patient.

 

  1. A patient, in the intensive care unit, has been NPO for several days. The nurse is

unable to assess bowel sounds. Which of the following should be included in this

patient’s plan to support nutritional needs?

  1. maintain NPO status
  2. determine best enteral feeding approach and plan implementation
  3. prepare to assist with implementation of a large bore venous access device to support total parenteral nutrition
  4. begin oral feeding with a diet as tolerated as soon as bowel sounds return

 

Answer: 2

 

Rationale: <P>Readiness for enteral feeding should not be determined by the presence of bowel sounds. Active bowel sounds have been used as criteria to initiate feeding, but there is no scientific evidence to support this practice. Bowel sounds are a poor indicator of small bowel motility and nutrient absorption, as they are the result of air passing through the intestinal tract. Waiting for bowel sounds places the patient at undue risk for malnutrition. The patient should not be maintained on NPO status only because of the absence of bowel sounds. Total parenteral nutrition might expose the patient to unnecessary pathogens which could compromise the healing process. The patient may or may not be able to tolerate oral feedings with a diet as tolerated. Nutritional support should not wait until the presence of bowel sounds.

 

Cognitive Level: Applying

 

Nursing Process: Planning

 

Client Need: Physiological Integrity

 

</P>

 

 

 

 

 

 

 

 

 

 

 

LO: 33-3. Describe enteral nutrition, including the benefits and potential complications, rationale for gastric versus postpyloric feeding, and barriers to providing optimal enteral nutrition to the high-acuity patient.

 

  1. The nurse is assessing a patient’s ability to receive enteral feedings. Which of the

following would be a contraindication for this type of nutritional support?

  1. gastric ulcer
  2. duodenal ulcer
  3. mechanical obstruction
  4. Crohn’s disease

 

Answer: 3

 

Rationale: C</H3><P>ontraindications to enteral nutrition have diminished as its safety and efficacy has been demonstrated in many types of high acuity patients. </P>Mechanical obstruction is the only absolute contraindication to enteral feedings. Gastric ulcer, duodenal ulcer, and Crohn’s disease are not contraindications for receiving enteral nutritional support.

Cognitive Level: Analyzing

 

Nursing Process: Assessment

 

Client Need: Physiological Integrity

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LO: 33-3. Describe enteral nutrition, including the benefits and potential complications, rationale for gastric versus postpyloric feeding, and barriers to providing optimal enteral nutrition to the high-acuity patient.

 

  1. A patient, with a history of aspiration pneumonia, is going to receive enteral feedings.

Which of the following should be considered regarding the tube and placement for this

patient?

  1. Gastric feedings provide more calories and better tolerance.
  2. Postpyloric feedings need to be interrupted and would not support the patient’s nutritional needs.
  3. Gastric feedings are ideal as long as the patient is receiving a proton pump inhibitor.
  4. Postpyloric feedings have less incidence of aspiration pneumonia and would be preferred for this patient.

 

Answer: 4

 

Rationale: Because it is documented that postpyloric feedings can be provided with less interruption and a higher nutritional intake, there is a lower incidence of pneumonia in some patients. This should be considered during the tube and placement for the patient. Gastric feedings are usually interrupted and would not necessarily provide more calories for the patient. Postpyloric feedings do not need to be interrupted as much. Proton pump inhibitors change the stomach pH and do not support the stomach’s ability to fight bacteria.

 

Cognitive Level: Analyzing

 

Nursing Process: Planning

 

Client Need: Physiological Integrity

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LO: 33-3. Describe enteral nutrition, including the benefits and potential complications, rationale for gastric versus postpyloric feeding, and barriers to providing optimal enteral nutrition to the high-acuity patient.

 

  1. A patient, receiving nasogastric tube feedings, has a gastric residual volume of 450 cc.

Which of the following should the nurse do to support this patient’s nutritional needs?

  1. hold the tube feeding until the gastric aspirate is less than 100 cc
  2. hold the tube feeding until the gastric aspirate is less than 250 cc
  3. provide the tube feeding as a bolus
  4. provide the tube feeding as a continuous infusion

 

Level: 2

 

Rationale: A common intervention for high gastric residual volume is to hold the enteral feeding for 1 to 2 hours until the residual volume is less than 200 to 250 cc from a nasogastric tube or less than 100 cc from a gastrostomy tube. The patient’s tube feeding should be held until the aspirate is less than 250 cc. It is not necessary to wait until the gastric residual volume is less than 100 cc since this is a nasogastric tube and not a gastrostomy tube. The nurse should not provide the tube feeding as a bolus and should not provide the tube feeding as a continuous infusion.

Cognitive Level: Applying

 

Nursing Process: Implementation

 

Client Need: Physiological Integrity

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LO: 33-3. Describe enteral nutrition, including the benefits and potential complications, rationale for gastric versus postpyloric feeding, and barriers to providing optimal enteral nutrition to the high-acuity patient.

 

  1. A patient has a clogged postpyloric feeding tube. Which of the following should the

nurse do to help this patient?

  1. irrigate the tube with a large amount of pressure to break the clog
  2. use a stylet to break through the clog
  3. slowly attempt to irrigate the tube with warm water
  4. pull the tube and insert another

 

Answer: 3

 

Rationale: To dislodge a clogged tube, irrigate the tube with warm water, cola, or juice. Also, using a syringe with alternating positive and negative pressure can dislodge a clog. The nurse should not irrigate the tube with large amounts of pressure. Using a stylet to break up a clog can cause an esophageal or gastric mucosa tear. Efforts should be undertaken to dislodge the clog before pulling the tube and inserting another.

 

Cognitive Level: Applying

 

Nursing Process: Implementation

 

Client Need: Physiological Integrity

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LO: 33-4. Discuss the parenteral methods used to provide nutrition for the high-acuity patient, including potential complications.

 

  1. A patient is being transitioned from total parenteral nutrition delivered through a

central venous catheter to oral feedings. Which of the following would most likely

occur with this patient?

  1. provide peripheral parenteral nutrition for several days and progress as tolerated
  2. pull the central venous catheter and provide oral meals as tolerated
  3. pull the central venous catheter and insert a nasogastric tube for enteral feedings
  4. cap the central venous catheter; provide peripheral parenteral nutrition and enteral feedings through a postpyloric tube

 

Answer:  1

 

Rationale: Peripheral parenteral nutrition is infused into smaller, peripheral veins, and is often used for short-term nutrition support, or as a supplement during transitional phases to enteral or oral nutrition routes. The patient will need a transition from total parenteral nutrition prior to going directly to oral feedings. Providing peripheral parenteral nutrition for several days with progressing as tolerated is the appropriate method for this patient. The central venous catheter should not be pulled and the patient moved immediately to oral feedings or to enteral feedings through a nasogastric tube. The central venous access device can be capped however if it is not known if the patient needs both peripheral parenteral nutrition and enteral feedings through a postpyloric tube.

Cognitive Level: Analyzing

 

Nursing Process: Planning

 

Client Need: Physiological Integrity

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LO: 33-4. Discuss the parenteral methods used to provide nutrition for the high-acuity patient, including potential complications.

 

  1. The nurse is caring for a patient with a large bore catheter for total parenteral

nutrition. Which of the following would indicate to the nurse that the patient might be

experiencing catheter related sepsis?

  1. heart rate 90 beats per minute and regular
  2. chills and fever when hanging a new infusion bag
  3. blood pressure 138/88 mm Hg
  4. urine output 50 cc/hour

 

Answer: 2

 

Rationale: Signs and symptoms of catheter related sepsis include: sudden onset of fever, rigors, or chills that coincide with parenteral infusion; erythema, swelling, tenderness, or purulent drainage from the catheter site; sudden temperature elevation that resolves on catheter removal; leukocytosis; sudden glucose intolerance that may occur up to 12 hours before temperature elevation; and bacteremia/septicemia/septic shock. Heart rate of 90 beats per minute and regular is not an indication of catheter related sepsis. A blood pressure of 138/88 mm Hg is not an indication of catheter related sepsis. Urine output of 50 cc/hour is a normal urine output.

 

Cognitive Level: Analyzing

 

Nursing Process: Assessment

 

Client Need: Physiological Integrity

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LO: 33-4. Discuss the parenteral methods used to provide nutrition for the high-acuity patient, including potential complications.

 

  1. A patient, receiving total parenteral nutrition, has elevated serum blood urea nitrogen

and serum sodium levels. Which of the following do these assessment findings

suggest to the nurse?

  1. catheter related sepsis
  2. hepatic dysfunction
  3. hyperglycemia
  4. prerenal azotemia

 

Answer: 4

 

Rationale: Prerenal azotemia is caused by overaggressive protein administration and is aggravated by underlying dehydration. Presenting signs and symptoms include an elevated serum BUN, serum sodium, and clinical signs of dehydration. Signs and symptoms of catheter related sepsis include: sudden onset of fever, rigors, or chills that coincide with parenteral infusion; erythema, swelling, tenderness, or purulent drainage from the catheter site; sudden temperature elevation that resolves on catheter removal; leukocytosis; sudden glucose intolerance that may occur up to 12 hours before temperature elevation; and bacteremia/septicemia/septic shock. Hepatic dysfunction would be assessed with serum liver function tests and bilirubin levels. Hyperglycemia would be a blood glucose level of greater than 220 mg/dL while receiving total parenteral nutrition.

 

Cognitive Level: Analyzing

 

Nursing Process: Assessment

 

Client Need: Physiological Integrity

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LO: 33-4. Discuss the parenteral methods used to provide nutrition for the high-acuity patient, including potential complications.

 

  1. After the insertion of a central venous catheter for total parenteral nutrition, the patient

demonstrates dyspnea with complaints of chest pain radiating to the back. Which of

the following should the nurse suspect is occurring with this patient?

  1. catheter fracture
  2. arterial puncture
  3. air emboli
  4. pneumothorax

 

Answer: 4

 

Rationale: Pneumothorax is caused by the puncture or laceration of the pleura on insertion of the needle/catheter. Common symptoms include shortness of breath, restlessness, hypoxia, and chest pain radiating to the back. Catheter fracture would not typically occur upon insertion but occur over time. Arterial puncture would be indicated by a flashback of arterial blood in the syringe, pulsatile blood flow, bleeding from the catheter site or development of a large hematoma, and hypotension. Signs and symptoms of an air emboli vary with the amount of air pulled into the venous system but may include respiratory distress, tachycardia, hypotension, sudden cardiovascular collapse, neurologic deficits, or cardiac arrest.

 

Cognitive Level: Analyzing

 

Nursing Process: Assessment

 

Client Need: Physiological Integrity

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LO: 33-4. Discuss the parenteral methods used to provide nutrition for the high-acuity patient, including potential complications.

 

  1. A patient is suspected of having an air emboli from a central venous line inserted for

total parenteral nutrition. Which of the following should the nurse do to support this

patient?

  1. place the patient on the right side flat position
  2. place the patient on the left side Trendelenburg position
  3. raise the head of the bed up to 30 degrees
  4. place the patient on the left side reverse Trendelenburg position

 

Answer: 2

 

Rationale: When air embolus is suspected, immediate action is required. The patient should be placed on the left side and in the Trendelenburg position. This allows an air embolus to float into the right ventricle of the heart, away from the pulmonary artery. The other position choices are incorrect and would not help the patient.

 

Cognitive Level: Applying

 

Nursing Process: Implementation

 

Client Need: Physiological Integrity

 

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