Nursing Elites

1. The nurse is working with a patient who recently had a stroke. The patient frequently chokes and coughs when eating and is having difficulty feeding herself. What is the best way to ensure adequate nutrition?

• A. to have an aide feed her at each meal
• B. to ask a family member to assist during meals
• C. to provide tube feedings for the patient
• D. to initiate TPN for the patient

Correct answer: C

Rationale: The best way to ensure adequate nutrition for a stroke patient who frequently chokes and coughs when eating and has difficulty feeding herself is to provide tube feedings. Tube feedings are a safe and effective method to deliver nutrition directly to the stomach or intestines, bypassing the swallowing mechanism, reducing the risk of aspiration. Having an aide feed her each meal (choice A) may not address the underlying issue of swallowing difficulty and aspiration risk. Asking a family member to be present at each meal (choice B) does not provide a definitive solution to the patient's nutritional needs. Placing the patient on total parenteral nutrition (TPN) (choice D) is a more invasive and typically reserved for patients who cannot tolerate enteral feedings or have non-functional gastrointestinal tracts.

2. Because of increasing cases of fluorosis, low levels of fluoride are added to commercial infant formula. Breast milk provides low levels of fluoride.

• A. Both statements are true
• B. Both statements are false
• C. The first statement is true; the second is false
• D. The first statement is false; the second is true

Correct answer: D

Rationale: The first statement is false; fluoride is not added to infant formulas due to the risk of fluorosis. The second statement is true; breast milk contains low levels of fluoride.

3. How many calories are contained in a food that has 15 grams of carbohydrates, 4 grams of protein, and 10 grams of fat?

• A. 106
• B. 124
• C. 166
• D. 202

Correct answer: C

Rationale: To calculate the total calories in a food item, you can use the following conversions: every 1 gram of carbohydrate provides 4 calories, 1 gram of protein provides 4 calories, and 1 gram of fat provides 9 calories. Therefore, for this food item, multiply 15 grams of carbohydrates by 4 calories/gram, 4 grams of protein by 4 calories/gram, and 10 grams of fat by 9 calories/gram. The calculation would be (15 * 4) + (4 * 4) + (10 * 9) = 60 + 16 + 90 = 166 calories. Choice A (106) is incorrect because it does not consider the calories from fat. Choice B (124) is incorrect as it underestimates the calories by not including all macronutrients. Choice D (202) is incorrect as it overestimates the calories by adding up the values incorrectly.

4. In consideration of the steps in applying the bag technique, which side of the paper lining of the CHN bag is considered clean to make a non-contaminated work area?

• A. The lower lip
• B. The outer surface
• C. The upper tip
• D. The inside surface

Correct answer: B

Rationale: Nursing interventions should be grounded in a deep understanding of the physiological processes involved, ensuring that care provided is both effective and efficient.

5. What level of sodium restriction would be included as part of nutrition therapy for heart failure?

• A. Less than 500 mg per day
• B. 1000 mg to 1500 mg per day
• C. 1500 mg to 3000 mg per day
• D. 3000 to 3500 mg per day

Correct answer: C

Rationale: The correct answer is 1500 mg to 3000 mg per day. This is the level of sodium restriction typically recommended for heart failure patients. It helps manage fluid retention and reduce blood pressure, which are both crucial in treating heart failure. A sodium intake of less than 500 mg per day (Choice A) might be too restrictive and is not typically recommended. Similarly, an intake of 1000 mg to 1500 mg per day (Choice B) falls short of the recommended range. Lastly, an intake of 3000 to 3500 mg per day (Choice D) exceeds the recommended upper limit, potentially exacerbating fluid retention and high blood pressure.

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