Question 1

The nurse is caring for a patient who is being treated with total parenteral nutrition (TPN). The patient is experiencing chest pain, and the nurse observes shortness of breath and coughing along with cyanosis. The nurse understands that this patient is most likely experiencing which condition?

Accepted Answer

A)   Air embolism
B)   Pneumonia
C)   Pneumothorax
D)   Pulmonary edema A

Question 2

The nurse is caring for an adult with severe burns who weighs 60 kg. Prior to initiating total parenteral nutrition (TPN) therapy, the nurse reviews the orders. Which TPN order is correct for this patient?

Accepted Answer

A)   3000 kcal, 120 g amino acids per day
B)   2400 kcal, 50 g amino acids per day
C)   1500 kcal, 100 g amino acids per day
D)   3600 kcal, 150 g amino acids per day A

Question 3

The nurse is caring for a patient who is receiving total parenteral nutrition (TPN). The patient reports nausea, headache, and thirst. The nurse will contact the provider to discuss which of the following?

Accepted Answer

A)   giving acetaminophen for headache pain.
B)   obtaining a serum glucose level.
C)   ordering an antiemetic to prevent vomiting.
D)   starting intravenous isotonic dextrose. B

Question 4

The nurse is preparing to administer enteral nutrition to a patient. Which assessment finding would prompt the nurse to hold the nutrition and notify the patient's provider?

Accepted Answer

A)   Blood pressure of 90/60 mm Hg
B)   Decreased bowel sounds
C)   A productive cough
D)   A temperature of 37.8° C

Question 5

The nurse is preparing a patient who will receive intermittent enteral nutrition at home with a hyper-osmolar solution. What information will the nurse include when teaching this patient?

Accepted Answer

A)   How to perform the Valsalva maneuver
B)   The need to consume extra fluids between feedings
C)   The need to decrease dietary fiber
D)   The need to remain supine during infusion of the enteral solution

Question 6

The nurse is preparing to discontinue total parenteral nutrition (TPN) therapy for a patient who has been receiving TPN for several days. The nurse will contact the provider to discuss an order for:

Accepted Answer

A)   antibiotics.
B)   intravenous insulin.
C)   isotonic dextrose.
D)   nasogastric feedings.

Question 7

The nurse is preparing to administer enteral nutrition to a patient who has had a stroke and who cannot swallow. A family member asks why the patient is not receiving intravenous nutrition. What information will the nurse provide to the family member?

Accepted Answer

A)   Parenteral nutrition carries a higher risk of infection.
B)   Parenteral nutrition does not provide sufficient calories.
C)   Parenteral nutrition increases the risk of aspiration.
D)   Parenteral nutrition is hyper-osmolar and increases the risk of dehydration.

Question 8

The nurse assumes care of a patient who has been receiving intermittent enteral feedings of 240 mL of a polymeric formula every 4 hours for the past 48 hours. The patient is in bed with the head of the bed elevated 60 degrees. The enteral tubing is intact, and the enteral pump is infusing at 320 mL per hour. The nurse notes 60 mL of solution left in the bag. The tubing is not labeled. What will the nurse do?

Accepted Answer

A)   Change and label the enteral tubing when this infusion is complete.
B)   Increase the infusion rate to 480 mL per hour to complete the infusion.
C)   Lower the head of the bed to 30 degrees.
D)   Stop the infusion and check for residual before resuming the infusion.

Question 9

Which patient is most likely to be a candidate for total parenteral nutrition (TPN) rather than enteral nutrition?

Accepted Answer

A)   A patient who is comatose after having had a stroke
B)   A patient who has a fractured mandible following a motor vehicle accident
C)   A patient who has cerebral palsy and severe dysphagia
D)   A patient who is pregnant and has intractable hyperemesis gravidarum

Question 10

The nurse is preparing to hang a new bag for a patient who is receiving total parenteral nutrition (TPN). During this procedure, the nurse will instruct the patient to take a deep breath and then perform which action?

Accepted Answer

A)   Exhale slowly and bear down.
B)   Exhale slowly to the count of 10.
C)   Hold the breath and bear down.
D)   Take several rapid, shallow breaths.

Question 11

A patient who has been receiving total parenteral nutrition (TPN) for several days accidently removes the intravenous (IV) line. While waiting for the IV therapy nurse, the nurse caring for this patient will monitor for which complication?

Accepted Answer

A)   Air embolism
B)   Dehydration
C)   Hypoglycemia
D)   Infection

Question 12

The nurse dilutes an antibiotic before administering it through a patient's nasogastric tube. The patient asks why this is necessary. The nurse explains that diluting the antibiotic helps to:

Accepted Answer

A)   improve absorption.
B)   improve hydration.
C)   prevent diarrhea.
D)   prevent emboli.

Question 13

A patient who has been receiving continuous enteral nutrition has had several large, watery stools. The nurse will contact the provider to discuss which intervention?

Accepted Answer

A)   Administering antidiarrheal medications
B)   Slowing the rate of infusion
C)   Starting total parenteral nutrition
D)   Thickening the nutrition solution

Question 14

A patient receiving total parenteral nutrition (TPN) begins having cough and dyspnea. The nurse auscultates rales and notes neck vein engorgement and weight gain. The nurse suspects that the patient is experiencing which condition?

Accepted Answer

A)   Air embolism
B)   Fluid overload
C)   Pneumonia
D)   Pneumothorax

Question 15

The nurse is preparing to administer an enteral feeding to a patient who receives 300 mL of a polymeric formula over 30 minutes every 4 hours. The nurse checks the residual prior to initiating the feeding and notes a residual amount of 50 mL of formula. Which action will the nurse take next?

Accepted Answer

A)   Administer the feeding as ordered.
B)   Administer the feeding over 60 minutes.
C)   Hold the feeding and notify the patient's provider.
D)   Wait 1 hour and recheck the residual again.

Question 16

The nurse assumes care for a patient and is preparing to administer an enteral feeding. The nurse finds the patient supine and asleep. The nurse will perform which action prior to initiating the feeding?

Accepted Answer

A)   Elevate the head of the bed 30 degrees.
B)   Flush the tubing with water.
C)   Position the patient to the left side.
D)   Temporarily discontinue the infusion.

Question 17

The provider calculates the enteral nutrition needs for a non-ambulatory patient and determines that the patient will need 300 mL of a polymeric formula every 4 hours. Which method of delivery will the nurse use to administer these feedings?

Accepted Answer

A)   300 mL every 4 hours given via syringe as a 10-minute bolus
B)   300 mL every 4 hours given via enteral pump as a 45-minute infusion
C)   75 mL per hour via enteral pump as a continuous infusion
D)   150 mL every 2 hours via gravity infusion

Question 18

The nurse is caring for a patient who is receiving total parenteral nutrition (TPN). The nurse will carefully monitor this patient for which symptom(s)?

Accepted Answer

A)   Coughing and shortness of breath
B)   Decreased breath sounds
C)   Diarrhea
D)   Nausea and abdominal distension

Question 19

The nurse is caring for a patient with severe burns who will begin receiving total parenteral nutrition (TPN). The patient asks why TPN is necessary. The nurse explains that TPN is used for which reason?

Accepted Answer

A)   To minimize pulmonary complications
B)   To prevent hyperglycemia and fluid overload
C)   To promote wound healing and maintain cell integrity
D)   To restore fluid and electrolyte imbalance

Exam 14: Nutritional Support

The nurse is caring for a patient who is being treated with total parenteral nutrition (TPN) . The patient is experiencing chest pain, and the nurse observes shortness of breath and coughing along with cyanosis. The nurse understands that this patient is most likely experiencing which condition?