Chapter 31 Malnutrition

Black & Hawks: Medical-Surgical Nursing: Clinical Management for Positive
Outcomes, 7th Edition
Chapter 31: Management of Clients with Malnutrition
MULTIPLE CHOICE
1. The nurse’s action that will best prevent clogging of the gastric feeding tube is to
a. check tube placement every 4 hours.
b. apply intermittent suction.
c. adhere to the tube flushing protocol.
d. periodically reposition the tube.
ANS: c
Tubes of any diameter will clog without strict adherence to a flushing protocol. The other options
do not contribute to the non-clogging of the tube.
DIF: Cognitive Level: Application REF: Text Reference: 704

TOP: Nursing Process Step: Intervention
MSC: NCLEX: Safe, Effective Care Environment;
2. The nurse teaching a family member how to position a client who is to receive tube feedings
would suggest
a. placing the client in a left side-lying position with the head of the bed flat.
b. elevating the head of the bed slightly.
c. encouraging the client to move out of bed into a chair.
d. allowing the client to assume a position of comfort.
ANS: b
The head must be elevated at least 45 degrees for 1 hour before and 1 hour after feeding. The
upright position helps to reduce the possibility of aspiration.
DIF: Cognitive Level: Application

REF: Text Reference: 703, Bridge to Home Health Care;
MSC: NCLEX: Health Promotion and Maintenance
3. The nurse explains that in the administration of total parenteral nutrition (TPN), an unsuitable
site is the
a. vena cava.
b. jugular vein.
c. brachial vein.
d. subclavian vein.
ANS: 3
TPN is usually infused into the central venous circulation because peripheral vessels are too
small to dilute the feeding, becoming inflamed.
Chapter 31: Management of Clients with Malnutrition 2

4. To help prevent hyperglycemia in a client receiving TPN, the nurse would

a. use an infusion pump.
b. administer the solution slowly.
c. protect the solution from light.
d. keep the infusion at room temperature.
ANS: a
TPN must be delivered using a pump to control the infusion rate accurately and to prevent the
possibility of a bolus and consequent hyperglycemia.

5. The nurse can reduce the risk of access site infection in a client receiving TPN by
a. changing the transparent dressing every 72 hours.
b. changing the catheter every 48 hours.
c. adding antibiotics to the TPN fluid.
d. using a semipermeable dressing on the insertion site.
ANS: a
Gauze dressings are changed every 48 hours and transparent dressings every 3 to 7 days.
DIF: Cognitive Level: Comprehension REF: Text Reference: 708

6. An older client has had a urinary tract infection for 5 weeks despite the use of several
antibiotics. The home health nurse assesses that the prolonged period of infection is
associated with
a. resistant organisms.
b. poor nutritional state.
c. tight underwear.
d. inadequate hygiene.
ANS: b
States of poor nutritional status and malnutrition affect the immune system and prolong illnesses
and infections despite the use of antibiotics.

TOP: Nursing Process Step: Assessment
Elsevier items and derived items  2005 by Elsevier Inc.

7. In the initial assessment of a client with bulimia, the nurse would inquire about
a. binge-eating episodes.
b. flatulence.
c. black tarry stools.
d. hyperactivity.
ANS: a
Clinical manifestations of bulimia nervosa include episodes of binge eating followed by self-
induced vomiting.

8. A client who is diagnosed with bulimia would be most likely to manifest the psychosocial
alteration of
a. social withdrawal.
b. denial of abnormal eating.
c. depression.
d. self-mutilation.
ANS: c
Personality characteristics typical of clients with bulimia are related to depression.
DIF: Cognitive Level: Comprehension REF: Text Reference: 713

9. After discussing reasonable weight loss goals with a client who is 5½ feet tall and weighs
210 pounds, the nurse would see the need for further teaching with the client’s statement that
a. “I will try to eat very slowly.”
b. “I will limit my intake to 500 calories a day.”
c. “I’ll try to pick foods from all five of the basic food groups.”
d. “It’s important for me to begin a regular exercise program.”
ANS: b
A balanced hypocaloric diet in the range of 1100 to 1200 kcal daily is regarded as the most
successful approach to long-term diet modification. An exercise program should be part of the
overall care of the obese client.

TOP: Nursing Process Step: Evaluation
10. The nurse preparing a postoperative teaching plan for a client who had a gastric stapling
would include that
a. fluids must be taken in liberal amounts.
b. small, frequent feedings must become a habit.

c. exercise is prohibited after meals.

d. dumping syndrome is common for the first 6 months after surgery.
ANS: b
Diet instructions must be part of the postoperative care, focusing on the frequency and size of
meals.

11. The client manifestation noted by the nurse as inconsistent with malnutrition is
a. constipation.
b. delayed wound healing.
c. postural hypotension.
d. fatigue.
ANS: a
Diarrhea is a manifestation of the effects malnutrition has on gastrointestinal function.
DIF: Cognitive Level: Comprehension REF: Text Reference: 691, Table 31-1;
TOP: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity
12. The nurse explains to a client with renal failure who requires an oral nutritional supplement
that the most appropriate brand would be
a. Nutra Shake.
b. Boost Plus.
c. Nepro.
d. Probalance.
ANS: c
Nepro is specialized for clients with renal failure who are receiving dialysis; it is low in
electrolytes and volume.
DIF: Cognitive Level: Comprehension REF: Text Reference: 694, Table 31-3;
TOP: Nursing Process Step: Intervention MSC: NCLEX: Physiological Integrity
13. The nurse should assist the malnourished client with oral hygiene by encouraging
a. rinsing with warm saltwater.
b. use of a firm-bristle toothbrush.
c. use of alcohol-containing mouthwash.
d. use of glycerin and lemon swabs.
ANS: a
Routine mouth care should include (a) cleansing the mouth after each meal and at bedtime, (b)
using a soft-bristle toothbrush, (c) rinsing with warm saltwater, and (d) avoiding alcohol-
containing mouthwash or glycerin and lemon juice.


14. In feeding a client with a cognitive impairment, the least helpful nursing action is to
a. create a quiet, unhurried environment.
b. distract the client with conversation.
c. provide several small meals.
d. orient the client to the purpose of feeding equipment.
ANS: b
The nurse should only provide frequent cues to the client (e.g., “Mrs. S, pick up the toast.” or
“Mr. S, chew the food in your mouth.”). Conversation or other distractions from the meal should
be avoided.
DIF: Cognitive Level: Analysis REF: Text Reference: 697

15. When assisting a dysphagic client to eat, the nurse should

a. place the client in the semi-Fowler’s position.
b. have the client slightly flex the neck for swallowing.
c. place the client in the Sims position for 15 minutes after each meal.
d. use the fingers to check the client’s mouth for food around dentures.
ANS: b
Slightly flexing the head forward may aid in swallowing. A high-Fowler’s position with 90-
degree flexion of the hips is usually the best position for mealtime. Maintaining the high-
Fowler’s position for at least 30 minutes after a meal helps reduce reflux and aspiration. For
safety, the nurse should never place unprotected fingers in the client’s mouth when teeth or
dentures are in place.
DIF: Cognitive Level: Application

REF: Text Reference: 698, Bridge to Home Health Care;
16. Before administering enteral feeding, the nurse can ensure proper tube placement by
a. extracting stomach contents from the tube.
b. auscultating the stomach as 10 ml of water is injected.
c. holding the end of the tube under water to check for bubbling.
d. asking the client to swallow.
ANS: a
The confirmation of stomach contents is the best indication that the feeding tube is still in place.


17. A client who has begun receiving TPN develops shaking chills, shortness of breath, and chest
pain. The nurse immediately shuts off the infusion, interpreting these manifestations as
allergy to
a. multivitamins.
b. trace elements.
c. protein.
d. lipids.
ANS: d
Although rare, allergic reactions to intravenous lipid preparations have been reported and usually
present within 30 minutes. A clinical manifestation of reactions can include fever, shaking chills,
shortness of breath, chest pain, or back pain.

TOP: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity
18. The nurse providing instructions to a client who will be discharged to home with self-
administered bolus enteral feedings would teach the client to infuse the feeding over
a. 2 to 10 minutes.
b. 10 to 15 minutes.
c. 15 to 30 minutes.
d. 30 to 60 minutes.
ANS: b
Bolus feedings are usually delivered over 10 to 15 minutes.

TOP: Nursing Process Step: Intervention MSC: NCLEX: Physiological Integrity
19. A nurse hangs a bag containing enteral nutrition formula for a client at 8 AM. The nurse will
return at
a. 9 AM to change the tubing.
b. 10 AM to discard remaining formula and replace.
c. 12 noon to replace bag, tubing, and formula.
d. 1 PM to flush tubing and add formula.
ANS: c
Formulas administered through an open delivery system should hang for only 4 hours before
being changed and having the tubing flushed or rinsed.
DIF: Cognitive Level: Analysis REF: Text Reference: 703


20. A client with anorexia nervosa has a nursing diagnosis of Imbalanced Nutrition: Less than
Body Requirements related to inadequate food intake. The client’s current weight is 92
pounds. The nurse would evaluate that the client is making safe progress if the weight after 1
week is
a. 107 pounds.
b. 102 pounds.
c. 97 pounds.
d. 94 pounds.
ANS: d
Clients with severe nutritional depletion will be able to regain weight at a safe rate (1 to 2
pounds/week).

TOP: Nursing Process Step: Evaluation

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Black & Hawks: Medical-Surgical Nursing: Clinical Management for Positive

Outcomes, 7th Edition

Chapter 31: Management of Clients with Malnutrition

DIF: Cognitive Level: Application REF: Text Reference: 704

DIF: Cognitive Level: Application

DIF: Cognitive Level: Application REF: Text Reference: 707

4. To help prevent hyperglycemia in a client receiving TPN, the nurse would

DIF: Cognitive Level: Application REF: Text Reference: 708

DIF: Cognitive Level: Comprehension REF: Text Reference: 708

DIF: Cognitive Level: Application REF: Text Reference: 690

Elsevier items and derived items  2005 by Elsevier Inc.

DIF: Cognitive Level: Application REF: Text Reference: 713

DIF: Cognitive Level: Comprehension REF: Text Reference: 713

DIF: Cognitive Level: Application REF: Text Reference: 712

Elsevier items and derived items  2005 by Elsevier Inc.

c. exercise is prohibited after meals.

DIF: Cognitive Level: Application REF: Text Reference: 712

Elsevier items and derived items  2005 by Elsevier Inc.

DIF: Cognitive Level: Application REF: Text Reference: 696

DIF: Cognitive Level: Analysis REF: Text Reference: 697

15. When assisting a dysphagic client to eat, the nurse should

DIF: Cognitive Level: Application

DIF: Cognitive Level: Application REF: Text Reference: 703

Elsevier items and derived items  2005 by Elsevier Inc.

MSC: NCLEX: Safe, Effective Care Environment;

DIF: Cognitive Level: Application REF: Text Reference: 708

DIF: Cognitive Level: Application REF: Text Reference: 701

DIF: Cognitive Level: Analysis REF: Text Reference: 703

Elsevier items and derived items  2005 by Elsevier Inc.

DIF: Cognitive Level: Application REF: Text Reference: 713

Elsevier items and derived items  2005 by Elsevier Inc.

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