ATI Nutrition Practice Exam

Correct Answer D: Disconnect the tube from suction source

Explanation of the correct answer:

The first action a nurse should take when preparing to remove a clogged nasogastric (NG) tube is to disconnect the tube from the suction source. This is crucial to ensure the suctioning equipment is not damaged or inadvertently turned on during the removal process. Disconnecting the suction ensures safety and prevents any accidental suction or harm while handling the NG tube.

Why the other options are incorrect:

A) Assist the client to blow her nose:

While blowing the nose could help relieve pressure or congestion, it is not directly related to removing a clogged NG tube. The primary concern in removing a clogged NG tube is to manage the tube safely and prevent injury to the client, and this step does not address that.

B) Ask the client to take a deep breath and hold it:

Asking the client to take a deep breath and hold it is typically done to help prevent aspiration during tube insertion or during other procedures involving the airway, but it is not required prior to removing an NG tube.

C) Pinch the proximal end of the tube:

Pinching the proximal end of the NG tube is not the first action to take. While pinching the tube may be important to prevent spilling or leakage during removal, the first step should always be ensuring that the suction source is disconnected to prevent any accidental suction or damage.

Summary:

The first step in preparing to remove a clogged NG tube is to disconnect it from the suction source to ensure safety and prevent unintended complications during the procedure.

Correct Answer:

A) Peanut butter sandwich on whole wheat bread w/2% milk

C) Yogurt topped w/granola & a banana

D) Meat lasagna w/buttered garlic bread

Explanation of the correct answers:

A) Peanut butter sandwich on whole wheat bread w/2% milk: This is a good snack choice because it provides a combination of protein (from the peanut butter), healthy fats, and carbohydrates (from the whole wheat bread), along with dairy for additional protein and calcium. These are all important for overall health and maintaining strength during cancer treatment.

C) Yogurt topped w/granola & a banana: Yogurt is a good source of protein and calcium, which is important during cancer treatment for bone health and muscle maintenance. The granola adds fiber, and the banana provides potassium and other essential vitamins. This combination makes for a balanced snack.

D) Meat lasagna w/buttered garlic bread: This meal choice is appropriate for a cancer client due to its high-protein content (from the meat and cheese), as well as carbohydrates (from the pasta and bread). It's an energy-dense option that helps provide the necessary nutrients during cancer treatment.

Why the other options are incorrect:

B) Popcorn w/soda: While popcorn can be a good source of fiber, it is often high in sodium and may not provide enough protein or other essential nutrients for a client with cancer. Additionally, soda is high in sugar and offers little nutritional value, making this an inappropriate snack choice.

E) Plain baked potato: A plain baked potato, while a good source of carbohydrates, does not provide sufficient protein or other important nutrients needed for a cancer client. A balanced snack should include a variety of macronutrients such as protein, healthy fats, and fiber.

Summary:

The nurse should recommend the peanut butter sandwich with whole wheat bread and 2% milk, yogurt with granola and banana, and meat lasagna with garlic bread, as these snacks are balanced, providing protein, healthy fats, carbohydrates, and essential nutrients needed for clients undergoing cancer treatment. Popcorn with soda and a plain baked potato are not adequate or balanced snack options.

Correct Answer B: Calcium

Explanation of the correct answer:

B. Calcium:

Calcium is essential for the transmission of nerve impulses. It plays a key role in the functioning of muscle contractions and the release of neurotransmitters. Calcium ions facilitate the electrical signals necessary for nerve impulse transmission and are involved in synaptic function (the communication between nerve cells). Calcium is also critical for bone health, but its role in nerve function is vital for maintaining proper neurological health.

Why the other options are incorrect:

A. Phosphorus:

Phosphorus is a vital mineral primarily involved in the formation of bones and teeth, and it helps in energy production within cells. However, it does not play a primary role in the transmission of nerve impulses. Calcium is the mineral specifically needed for that function.

C. Chloride:

Chloride is an essential mineral that helps maintain fluid balance and works in tandem with sodium to regulate blood volume and blood pressure. While chloride does participate in some electrolyte balance functions within the body, it is not directly involved in nerve impulse transmission like calcium.

D. Zinc:

Zinc is important for immune function, wound healing, and cell division. It is also involved in the synthesis of DNA and protein. Although zinc is critical for various bodily functions, it does not play a direct role in the transmission of nerve impulses.

Summary:

Calcium is the mineral necessary for the transmission of nerve impulses, as it is involved in neurotransmitter release and muscle contraction. The other minerals—phosphorus, chloride, and zinc—are important for other physiological functions but do not directly affect nerve impulse transmission.

Correct Answer B: Instruct the client to tuck her chin when swallowing.

Explanation of the correct answer:

B. Instruct the client to tuck her chin when swallowing:

The chin-tuck technique is a widely recommended and evidence-based intervention to reduce the risk of aspiration in clients with dysphagia or those at high risk. Tucking the chin towards the chest during swallowing helps close off the airway by bringing the epiglottis over the trachea and guiding food and liquids into the esophagus rather than the airway. This posture slows the bolus and gives the swallowing reflex more time to activate, enhancing safety.

Why the other options are incorrect:

A. Give the client thin liquids:

Thin liquids are more difficult to control during swallowing and are more easily aspirated. For clients at risk for aspiration, thickened liquids are preferred as they move more slowly and are easier to manage. Thin liquids should generally be avoided unless specifically recommended after a thorough swallowing assessment.

C. Have the client use a straw:

Using a straw may increase the risk of aspiration because it allows a larger volume of liquid to be delivered quickly to the back of the throat, reducing control over the bolus and increasing the likelihood of misdirection into the airway. Straws are often contraindicated for clients with swallowing difficulties unless specifically evaluated and recommended.

D. Encourage the client to lie down and rest after meals:

Lying down after meals increases the risk of gastroesophageal reflux and aspiration. Clients at risk for aspiration should be kept in a high Fowler’s position (90 degrees) during and for at least 30–60 minutes after meals to allow gravity to assist in keeping food in the stomach and preventing reflux or aspiration.

Summary:

The appropriate intervention for a client at high risk for aspiration is to instruct them to tuck their chin when swallowing. This technique helps reduce aspiration risk by promoting safe swallowing mechanics. The other options either increase the aspiration risk or contradict standard swallowing precautions.

Correct Answer B: Weight gain of 1.5 kg (3.3 lb) per day

Explanation of the correct answer:

B. Weight gain of 1.5 kg (3.3 lb) per day:

A rapid weight gain of 1.5 kg (3.3 lb) per day is an adverse effect of Total Parenteral Nutrition (TPN) and may indicate fluid retention or overfeeding. TPN provides a concentrated source of nutrients, and if administered too quickly or in excess, it can lead to fluid overload, which manifests as weight gain. This weight gain is often associated with edema and can be harmful to the client, especially if they have a history of cardiac or renal conditions.

Why the other options are incorrect:

A. Temperature 36.1°C (97°F):

A temperature of 36.1°C (97°F) is slightly below normal, but it is not a significant indication of an adverse effect of TPN. While temperature changes may occur for various reasons, this mild decrease in temperature is not typically associated with TPN-related complications.

C. Hemoglobin 16 g/dL:

A hemoglobin level of 16 g/dL is within the normal range and is not a sign of an adverse effect related to TPN. TPN typically does not affect hemoglobin levels directly unless there are issues with nutrition or blood loss. A level of 16 g/dL is considered healthy for most adults.

D. Blood glucose 98 mg/dL:

A blood glucose level of 98 mg/dL is within the normal range and does not indicate an adverse effect of TPN. While TPN can affect blood glucose levels, a value of 98 mg/dL is not concerning. Hyperglycemia (elevated blood glucose) can be a potential issue with TPN, but a blood glucose level of 98 mg/dL is considered stable.

Summary:

A weight gain of 1.5 kg (3.3 lb) per day is a concerning finding and suggests fluid retention or overfeeding, both of which are adverse effects associated with TPN. The other findings, including temperature, hemoglobin, and blood glucose levels, are within normal ranges and do not indicate TPN-related complications.

Correct Answer  A: Dextrose in 10% water

Explanation of the correct answer:

A) Dextrose in 10% water:

When a client is receiving total parenteral nutrition (TPN), it is important to maintain glucose levels and prevent hypoglycemia when a new bag of TPN is not available. Dextrose in 10% water (D10W) is an appropriate solution to infuse temporarily, as it provides glucose to prevent hypoglycemia, maintaining energy needs until the new bag of TPN arrives.

Why the other options are incorrect:

B) 0.45% sodium chloride:

This solution does not provide any calories or glucose, which are essential for a patient who is on TPN. It is an isotonic solution, primarily used for hydration, and would not help maintain blood sugar levels.

C) Dextrose 5% in LR:

While this solution contains dextrose, the concentration is only 5%, which may not be enough to maintain glucose levels for a patient on TPN. Additionally, lactated Ringer's (LR) contains electrolytes that may not be ideal for a patient who requires only glucose replacement without additional electrolytes.

D) 0.9% sodium chloride:

This solution is a saline solution and does not provide glucose or calories, so it is not appropriate for maintaining blood glucose levels in a client receiving TPN.

Summary:

When a new bag of TPN is unavailable, dextrose in 10% water (D10W) should be infused to prevent hypoglycemia and maintain glucose levels, as it provides the necessary caloric support. Other solutions like 0.45% sodium chloride, D5LR, and 0.9% sodium chloride do not provide the glucose needed for this purpose.

Correct Answer A: Add thickener to liquids.

Explanation of the correct answer:

A) Add thickener to liquids: The highest priority in managing a client with dysphagia on a full liquid diet is ensuring the safety of the client while swallowing. Adding thickener to liquids can help prevent aspiration, a serious complication in clients with dysphagia. Thicker liquids are easier to control and less likely to be aspirated into the lungs, reducing the risk of choking and aspiration pneumonia.

Why the other options are incorrect:

B) Educate the client about acceptable liquids: While education is important, ensuring that the liquids are safe to swallow and appropriately thickened takes priority. Education can follow once safety is addressed.

C) Perform a calorie count of consumed liquids: Performing a calorie count is important for nutritional assessment, but it is secondary to ensuring that the liquids are safe and manageable for the client to swallow without risk of aspiration.

D) Offer high-protein liquid supplements: Offering nutritional support is important for maintaining adequate nutrition, but ensuring safe swallowing by thickening liquids is the top priority in preventing aspiration risks in clients with dysphagia.

Summary:

The highest priority for a client on a full liquid diet due to dysphagia is ensuring that the liquids are appropriately thickened to reduce the risk of aspiration. This action ensures the client's safety while eating and swallowing, which is the most immediate concern. Educating the client, performing a calorie count, and offering high-protein supplements are important but secondary to the immediate safety concern of swallowing.

Correct Answer A: Green leafy vegetables

Explanation of the correct answer:

A) Green leafy vegetables: Warfarin is an anticoagulant that works by inhibiting the action of vitamin K, which plays a key role in blood clotting. Green leafy vegetables (such as spinach, kale, and lettuce) are rich in vitamin K, and excessive intake can interfere with the effectiveness of warfarin, potentially leading to clotting issues. Therefore, these should be eaten in moderation and the client should maintain a consistent intake to avoid fluctuations in the medication’s effect.

Why the other options are incorrect:

B) Whole grains: Whole grains do not significantly interact with warfarin. They are generally a healthy component of the diet and do not need to be restricted or eaten in moderation while on warfarin.

C) Fruits with skin: Fruits with skin, such as apples or pears, do not interact with warfarin. There is no need to restrict them unless the patient has other specific dietary concerns.

D) Nuts and seeds: Nuts and seeds do not have a significant interaction with warfarin and can be consumed as part of a healthy diet. However, clients should be cautious with portion sizes if they are managing other health concerns (such as calorie intake).

Summary:

Clients taking warfarin should eat green leafy vegetables in moderation because they are high in vitamin K, which can interfere with the medication's anticoagulant effects. Other foods like whole grains, fruits with skin, and nuts and seeds do not significantly affect warfarin therapy.

Correct Answer B: Baked potato

Explanation of the correct answer:

B. Baked potato:

Thiazide diuretics, such as hydrochlorothiazide, can cause potassium loss, increasing the risk for hypokalemia (low potassium levels). Clients taking thiazide diuretics are often instructed to consume potassium-rich foods to help replenish potassium and prevent deficiencies. A baked potato is an excellent source of potassium, making it an appropriate choice to support the client's nutritional needs while on this medication.

Why the other options are incorrect:

A. Navy beans and ham:

While navy beans are a good source of potassium, ham is high in sodium, which can contribute to fluid retention and exacerbate hypertension. Thiazide diuretics are prescribed to manage high blood pressure, and excessive sodium intake can counteract the medication's effect. Therefore, this food combination is not ideal.

C. Cheddar cheese:

Cheddar cheese is high in sodium and saturated fats. Excessive sodium intake can increase the risk of fluid retention and counteract the blood pressure-lowering effects of thiazide diuretics. This food does not support the client's needs in managing hypertension or preventing hypokalemia.

D. Beef broth:

Beef broth is typically high in sodium, which could contribute to fluid retention and elevated blood pressure, counteracting the desired effects of thiazide diuretics. Like cheddar cheese, this is not an appropriate food choice for a client on this medication.

Summary:

The client should choose a baked potato, as it is a potassium-rich food that helps counteract the potassium depletion caused by thiazide diuretics. The other food options either contain excessive sodium or are not ideal for supporting potassium levels, which is crucial for the client’s health while on thiazide therapy.