enteral feedings
To facilitate the insertion of the NG tube, you should A. instruct the patient to swallow during tube insertion. B. have the patient extend head after the tube has passed through nasopharynx. C. apply gentle force when meeting resistance.
A - CORRECT Yes. You have selected the correct response. Swallowing, especially by sipping water, closes the epiglottis over the trachea and thus helps direct the tube to the esophagus rather than to the airways. B - INCORRECTNo. This is not the correct choice. The patient should flex head toward chest after tube passes the nasopharynx. C - INCORRECT No. This is not the correct choice. Forcing against resistance can traumatize the patient's mucosa.
How do you measures the length for the clients nasoenteric tube?
Measure the distance from the tip of the nose to earlobe to the xiphoide process of the sternum. and adding an additional 20-30 cm
To minimize the transmission of micro-organisms during the enteral formula feeding through the NG tube, you should A. cleanse the top of the canned formula with an alcohol swab before opening it. B. wear a personal protective gown and mask during the procedure. C. change the syringe or feeding bag every 48 hours.
A - CORRECT Yes. You have selected the correct response. These actions are effective deterrents to the transmission of micro-organisms during enteral feeding administration. B - INCORRECTNo. This is not the correct choice. These actions are recommended for your own protection only if you have a reason to believe you will come into contact with the patient's body fluids or infected secretions. C - INCORRECTNo. This is not the correct choice. The syringe or bag should be changed every 24 hours.
How do you check the ph of a nasoenteric tube for proper placement?
Inject 30 ml of air into the tube and pull 5 to 10 ml of gastric content.
How often should residual volumes be checked for a nasoenteric tube?
every 4-6 hours
To minimize the transmission of micro-organisms while inserting the NG tube, you A. wear clean gloves during the procedure. B. obtain a culture of the nasal cavity prior to insertion. C. suction the patient's nose and mouth prior to insertion.
A - CORRECT Yes. You have selected the correct response. This action is an effective deterrent to the transmission of micro-organisms. B - INCORRECTNo. This is not the correct choice. It is not necessary to culture the nasal airway. C - INCORRECTNo. This is not the correct choice. Suctioning can traumatize the patient's mucosa, actually increasing the risk of infection and failing to prevent the transmission of pathogens.
To minimize the risk of trauma and discomfort for the patient when removing the NG tube, you A. slowly rotate the tube 180 degrees while pulling back on it. B. using the pull-pause method to remove the tubing gradually. C. Fold the tube onto itself while quickly pulling back on it.
A - INCORRECT No. This is not the correct choice. This action reduces friction of the tube on the mucous membranes as it is being advanced and not during removal. B - INCORRECTNo. This is not the correct choice. Gradual removal lengthens the time during which the patient will feel discomfort during removal. C - CORRECTYes. You have selected the correct response. Folding the tube prevents tube contents from draining into the patient's oropharynx. Quick removal minimizes discomfort.
How do you check residual for a nasoenteric tube?
aspirate until you feel resistance from the plunger and return the residual. Clean the tube with 30ml of water.
How often should the nurse flush the nasoenteric tube with 30 ml of water?
every 4 hours to prevent clogging
To regulate the flow of the enteral formula through the NG tube, you open the tubing and A. raise the syringe to a height no greater than 18 inches above the patient's head. B. apply gentle pressure with the syringe's plunger to direct the formula through the tube. C. introduce more formula gradually into the syringe as the fluid level drops.
A - CORRECT Yes. You have selected the correct response. This action will allow gravity to propel the formula safely and slowly through the NG tube. B - INCORRECTNo. This is not the correct choice. This is not the recommended method since rapid infusion of the formula may result in abdominal cramping and increase the risk of aspiration. C - INCORRECT No. This is not the correct choice. This action has no effect on the regulation of the formula's flow rate.
You explain to the patient and her parents that she will be receiving all nutrients from a continuous enteral feeding using a commercially prepared: A. polymeric formula. B. modular formula. C. elemental formula.
A - CORRECT Yes. You have selected the correct response. This formula provides whole nutrients to this patient who has an intact and functioning gastrointestinal tract. B - INCORRECTNo. This is not the correct choice. A modular formula contains single macronutrients and is not nutritionally complete. The patient would need to be able to eat other foods to obtain complete nutrition, and this patient is not able to ingest other foods due to the patient's need for reconstructive jaw surgery. C - INCORRECT No. This is not the correct choice. This patient has an intact gastrointestinal tract; therefore, she does not need a formula containing predigested nutrients.
To determine the length of tube that will achieve the proper insertion depth, you A. use the tube to measure the distance from the patient's naris to his ear lobe to the tip of his xiphoid process. B. mark the location on the tube that is 1½ times the distance from the patient's nose to his xiphoid process. C. review the provider's order for the length of tubing to be inserted to reach the patient's stomach.
A - CORRECT Yes. You have selected the correct response. This total measurement is the approximate length of tube to insert. B - INCORRECTNo. This is not the correct choice. This is not the recommended procedure for approximating the distance from the naris to the stomach. C - INCORRECT No. This is not the correct choice. You will not find this information in the provider's order for an NG tube insertion.
A 46-year-old patient is admitted with reports of nausea, vomiting, and intense epigastric pain centered near his umbilicus and radiating to his back. Which of the following actions should you perform first in preparation for inserting the NG tube? Please select from the options below. A. Lubricate the end of the tube with water-based jelly. B. Evaluate the patency of the patient's nares. C. Ask the client to extend his neck back against the pillow.
A - INCORRECT No. This is not the correct choice. Although you will lubricate the first few inches of the NG tube, it would not be your first preparatory step. B - CORRECTYes. Before beginning the insertion procedure, select the most appropriate naris by asking the client to occlude one nostril and breathe normally through the other, then repeat the procedure occluding the other nostril. The tube will pass more easily through the more patent naris. Also be sure to consider any irritation, sepal defects, facial fractures, and skin condition of the external nares. C - INCORRECT No. This is not the correct choice. Although this appropriate for the insertion of an NG tube, it would not be your first preparatory step.
An 81-year-old patient who experienced a cerebral vascular accident (CVA, stroke) 2 weeks ago receives enteral nutrition intermittently via nasogastric (NG) tube because of residual impaired swallowing. Since this patient is at high risk for aspiration, you should: A. administer half strength enteral formula. B. position the patient in a left lateral position with the head of the bed elevated. C. elevate the head of the patient's bed to a minimum of 30 degrees.
A - INCORRECT No. This is not the correct choice. Diluting the enteral feeding will not decrease the risk of aspiration. B - INCORRECTNo. This is not the correct choice. This action is useful if the flow of fluid through the tubing is impeded. Repositioning might move the tip of the tube away from the stomach wall, but it does not reduce the risk of aspiration. C - CORRECT Yes. You have selected the correct response. This action enlists the aid of gravity in preventing aspiration.
To maintain the patency of the NG tube when administering medication, you A. thoroughly crush and mix all the medications together, adding water as needed. B. add each medication directly to the enteral formula, blending it together thoroughly. C. flush the tubing with at least 15 mL of water before the first medication, between each medication, and after the last medication.
A - INCORRECT No. This is not the correct choice. It is not the recommended method since it may increase the risk of clogging of the tube and might trigger an undesirable reaction between the medication and the formula. Furthermore, not all medications may be crushed since doing so can alter their effectiveness. B - INCORRECTNo. This is not the correct choice. It is not the recommended method since it may increase the risk of clogging of the tube and trigger an undesirable reaction between the medication and the formula. C - CORRECTYes. You have selected the correct response. This is the recommended method; it minimizes the risk of the medications clogging the NG tube.
After initial verification of the NG tube's placement by x-ray, you should also verify placement by A. assessing for normal bowel sounds. B. auscultating while flushing 30 mL of air through the tube to hear "swooshing" sounds. C. testing the pH of an aspirated fluid sample from the NG tube.
A - INCORRECT No. This is not the correct choice. Normal bowel sounds do not assist in determining NG placement. B - INCORRECTNo. This is not the correct choice. This method is unreliable, particularly for patients who have small-bore tubes inserted. C - CORRECTYes. You have selected the correct response. The only truly reliable method of confirmation is an x-ray. After that, many policies require using two methods of verification, one of which is typically testing the pH of NG aspirate. Gastric fluid ranges from 0 to 4.0, while intestinal contents have a pH between 7.0 and 8.0. If the tube is in the lungs, the pH will be 6.0 or higher.
A 16-year-old patient is being considered for major oral surgery following a motor-vehicle crash that resulted in extensive damage to her lower jaw. Her recovery from the surgery will interfere with her oral intake for approximately 3 weeks. You explain to the patient that her physician has prescribed a small-bore nasogastric tube because: A. it does not cause discomfort upon insertion. B. it is best suited for short-term enteral feeding therapy. C. tube placement can be verified by injecting air through the tube and auscultating for gurgling sound
A - INCORRECT No. This is not the correct choice. Patients may experience gagging or discomfort when the tube is inserted. B - CORRECTYes. You have selected the correct response. This is the primary reason for selection, since a small-bore nasogastric tube is appropriate for therapy lasting less than 4 weeks. C - INCORRECT No. This is not the correct choice. Enteral tube placement should not be verified by this method because injection of air may also be heard if the tube is inadvertently placed in the patient's lungs.
You discuss the importance of providing the patient with adequate nutrition following major oral surgery. You review possible complications that can occur with enteral tube feeding and nursing interventions to decrease the likelihood of these complications, which include: A.evaluating tube feeding tolerance by checking gastric residual every 4 hours and holding feeding for residual greater than 200 mL. B.identifying a displaced tube by obtaining a gastrointestinal aspirate for pH measurement. C.preventing diarrhea by consulting with the dietician to change the formula to one that does not contain fiber.
A - INCORRECT No. This is not the correct choice. Plan to withhold feedings for residual volumes of greater than 500 mL or when two consecutive measurements (taken 1 hour apart) each exceed 250 mL. B - CORRECTYes. You have selected the correct response. While the gold standard for verifying tube placement is radiography, a secondary verification method includes determining the gastric pH. C - INCORRECTNo. This is not the correct choice. Formulas that contain fiber may reduce the incidence of diarrhea.
After you have introduced the prescribed amount of enteral formula through the NG tube, you attempt to maintain the patency of the tube by A. clamping the NG tube after you flush it. B. applying a clean cap to the open end of the NG tube. C. flushing the NG tube with 30 to 60 mL of water.
A - INCORRECT No. This is not the correct choice. This action minimizes the amount of air that is can enter into the patient's stomach. B - INCORRECTNo. This is not the correct choice. This action minimizes both the entry of micro-organisms into the NG tube and the leakage of fluid from the tube. C - CORRECTYes. You have selected the correct response. This action rinses the formula from the tube and helps minimize the possibility of clogging.
After completing the enteral feeding, you minimize the patient's risk for aspiration by A. auscultating the abdomen for the presence of normal bowel sounds. B. assuring proper NG tube placement according to the facility's policy. C. keeping the head of the patient's bed elevated at 30 to 45 degrees.
A - INCORRECT No. This is not the correct choice. This action should be done prior to initiating tube feedings as it evaluates the presence of gastric peristalsis, which, if absent, can increase the risk for aspiration if the feeding is administered. B - INCORRECTNo. This is not the correct choice. This action does help minimize the risk of aspiration, but it should be performed prior to, not after, completing the feeding. C - CORRECTYes. You have selected the correct response. This position minimizes the risk for backflow and discourages aspiration if reflux or vomiting occurs.
A nurse is preparing to insert an NG tube for a client who requires gastric decompression. Which of the following actions should the nurse perform before beginning the procedure. (Select all that apply) A. Review a signal the client can use if feeling any distress B. Lay a towel across the client's chest C. Administer oral pain medication D. Obtain a Dobhoff tube for insertion E. Have a petroleum-based lubricant available
A -CORRECT. Yes. the nurse should establish a means for the client to communicate that she wants to stop the procedure before inserting an NG Tube. B -CORRECT. Yes nurse should place a disposable towel across the client's chest to provide for a clean environment and protect the client's gown from becoming soiled. C.-INCORRECT. Because the purpose is to remove stomach contents, the procedure would also remove oral pain medication D. -INCORRECT. The nurse should plan to use the prescribed type of gastric decompression, which is a Salem sump, Miller Abbott or Levin. A dobhoff tube is for feeding. E. -INCORRECT. Use water based lubricant to reduce complications from aspiration
A nurse is caring for a client in a long term care facility who is receiving enternal feeding via an NG tube. Which of the following actions should the nurse complete prior to administering the tube feeding? (Select all that apply) A. Auscultate bowel sounds B. Assist the client to an upright position C. Test the pH of gastric aspirate D. Warm the formula to body temperature E. Discard any residual gastric contents
A. CORRECT - The nurse should auscultate for BS, because the pt's GI tract might not be able to absorb nutrients. The nurse should then withhold feedings and notify provider. B. CORRECT - The nurse should place the client in an upright position, with at least a 30 degree elevation of the head of the bed. This helps prevent aspiration. C. CORRECT - This verifies placement. D. INCORRECT - Enteral formula should be at room temperature. E. INCORRECT - Residual should be returned to the pt's stomach unless the volume of gastric content is greater than 250ml or the facility has other guidelines in place.
A nurse is delivering an enternal feeding to a client who has an NG tube in place for intermittent feedings. When the nurse pours water into the syringe after the formula drains from the syringe, the client asks the nurse why the water is necessary. Which of the following responses should the nurse make? A. Water helps clear the tube so it doesn't get clogged" B. Flushing helps make sure the tube stays in place C. This will help you get enough fluids D. Adding water makes the formula less concentrated.
A. CORRECT - the nurse should flush thereby keeping NG tube patent. B. INCORRECT - the tube should be secured via a securing device. C. INCORRECT - additional fluids should be administered as this amount is inadequate D. INCORRECT - Contact dietary staff to prepare formula according to the prescription before instilling.
An older adult patient in a long-term care facility is receiving intermittent enteral feedings in his room. His affect is flat, and the nurse suspects that he is feeling isolated. Which of the following interventions is appropriate for this patient? A. Encourage him to go to the dining room at meal times to talk with other patients. B. Suggest that he watch television while his feedings are being administered. C. Remind him that he can have visitors after his feeding administration times. D. Ask the facility chaplain to speak with the patient.
A. CORRECT. By encouraging the resident to maintain a normal schedule and social interactions, the nurse is helping to rebuild his social network and reverse patterns of isolation. B. INCORRECT. Although television can provide a useful distraction for some patients and might actually help improve this patient's mood, this diversion is not interactive; therefore, it is unlikely to reduce any feelings of isolation he might have. C. INCORRECT. Although visitation policies vary with the facility, generally visitors are permitted during meal times in long-term care facilities. This intervention will not improve the situation if the patient does not have a family and social network outside the facility. D. INCORRECT. It is inappropriate to contact the chaplain without first consulting with the patient.
To prevent a common complication of continuous enteral tube feedings, a nurse should A. limit the time the formula hangs to 4 hr. B. chill the formula prior to administration. C. deliver the formula at a brisk rate. D. allow the feeding bag to empty before refilling it.
A. CORRECT. Formula that hangs longer than 4 to 8 hr is at risk for bacterial contamination, typically manifested by the patient as diarrhea. B. INCORRECT. It is recommended that enteral formula be warmed to room temperature prior to administration. Cold formula can cause abdominal cramping. C. INCORRECT. Administering enteral formula too fast (generally, more than 200 to 300 mL over 10 to 20 min) can cause abdominal cramping, nausea, and vomiting. A lower rate of delivery improves tolerance. D. INCORRECT. This can result in an excessive infusion of air, which could cause vomiting.
A nurse inserting a nasogastric tube asks the patient to flex her head toward her chest after the tube passes through the nasopharynx. This action facilitates proper insertion of the tube by A. closing off the glottis. B. preventing curling of the tube in the mouth. C. allowing the patient to breathe through her mouth. D. opening the lower esophageal sphincter.
A. CORRECT. This action prohibits the tube from entering the trachea. B. INCORRECT. Instructing the patient to swallow will reduce discomfort and prevent trauma. C. INCORRECT. This action does not facilitate breathing through the mouth. D. INCORRECT. Because the tube is passing through the nasopharynx, the esophageal sphincter would not yet be involved.
A nurse is preparing to instill an enteral feeding for a client who has an NG tube in place. Which of the following actions is the nurse's highest assessment priority before preforming this procedure A. Check how long the feeding container has been open B. Verify the placement of the NG tube. C. Confirm the client does not have diarrhea D. Make sure the client is alert and oriented.
A. INCORRECT - Not the highest priority assessment B. CORRECT - greatest risk for pts receiving enteral feeding is injury from aspiration. The priority nursing assessment before initiating an enteral feeding is to verify proper placement of the tube C. INCORRECT - While this may be a complication of enteral feeding it is not the highest assessment priority D. INCORRECT - Not the highest assessment priority
A nurse is caring for a client who is receiving continuous enteral feedings. Which of the following nursing interventions is the highest priority when the nurse suspects aspiration of the feeding? A. Auscultate breath sounds B. Stop the feeding C. Obtain a chest x-ray D. Initiate oxygen therapy
A. INCORRECT - the nurse should listen to breath sounds when there is suspicion of aspiration however this is not the highest priority. B. CORRECT - greatest risk to pt. is aspiration pneumonia. The first action the nurse should take is to stop the feeding so that no more formula can enter the lungs. C. INCORRECT - not the highest priority D. INCORRECT - Oxygen therapy should be delivered whenever there is suspicion of aspiration, however this is not the highest priority.
A patient with a gastric ileus postoperatively requires nutritional support for approximately 2 weeks. Which of the following types of feeding tubes is appropriate for this patient? A. Nasogastric tube B. Nasointestinal tube C. Percutaneous endoscopic gastrostomy tube D. Percutaneous endoscopic jejunostomy tube
A. INCORRECT. A lack of motility in the stomach (gastric ileus) would prevent the digestion of enteral formula placed in the stomach. B. CORRECT. A nasointestinal tube allows postpyloric feeding by depositing enteral formula directly into the intestines. This is an appropriate choice for a patient who lacks stomach motility (gastric ileus) and requires short-term (less than 4 weeks) enteral feeding. C. INCORRECT. A lack of motility in the stomach (gastric ileus) would prevent the digestion of enteral formula placed in the stomach. D. INCORRECT. Placing enteral formula into the jejunum rather than the stomach is appropriate for a patient who lacks stomach motility (gastric ileus). However, a percutaneous tube is indicated for patients who require enteral feedings for more than 4 weeks.
Nasogastric tube feedings are an appropriate choice for a patient who A. has a paralytic ileus B. has recently experienced facial trauma. C. is postoperative following laryngectomy. D. has pancreatitis.
A. INCORRECT. A patient with a paralytic ileus has absence of gastrointestinal motility. Therefore, this is not an appropriate choice for the patient. B. INCORRECT. Due to the high risk of improper tube placement, patients with recent facial or nasal trauma should not have a nasoenteric tube placed. These patients are better candidates for surgical placement of a gastric or jejunal tube. C. CORRECT. Immediately following removal of the larynx, patients typically receive IV fluids or parenteral nutrition until the gastrointestinal tract recovers from anesthesia. Then, a nasogastric tube is inserted and left in place for about 7 to 10 days to provide enteral feedings until swallowing is safe and adequate. D. INCORRECT. Pancreatitis is inflammation of the pancreas; therefore, food and fluids are withheld to allow the pancreas to rest and reduce pancreatic secretion.
To prevent aspiration during the administration of an enteral tube feeding, a nurse should A. flush the feeding tube with 30 mL of water. B. add blue food coloring to the enteral formula. C. ensure the formula is at room temperature. D. place the patient in Fowler's position.
A. INCORRECT. Flushing the tube with water before and after administering a tube feeding helps ensure that the tube is patent and clear of any formula that could obstruct the tube. This is not done to prevent aspiration prior to feeding. B. INCORRECT. Although this practice was once used to help detect formula aspirated into the lungs by staining airway secretions, it has been associated with patients' deaths and is therefore no longer considered safe practice. C. INCORRECT. Although administering tube feeding formula at room temperature is preferable, it is done primarily to prevent stomach cramps. D. CORRECT. The Fowler's position is recommended during tube feeding to reduce the risk of regurgitation, which can lead to aspiration. If Fowler's is uncomfortable for the patient, an acceptable alternative is elevating the head of the bed at least 30°.
Which of the following formulas is appropriate to administer to a patient who has a dysfunctional gastrointestinal tract? A. Modular B. Elemental C. Polymeric D. Specialty
A. INCORRECT. Modular formulas are single-nutrient formulas and require a functioning gastrointestinal tract that can absorb whole nutrients. B. CORRECT. Elemental formulas contain predigested nutrients that are easy for a partially functional gastrointestinal tract to absorb. C. INCORRECT. Polymeric formulas are whole-nutrient formulas and require a functioning gastrointestinal tract that can absorb whole nutrients. D. INCORRECT. Specialty formulas meet specific needs of patients who have a particular disorder (HIV, liver failure), and they are not necessarily formulated for a patient with a nonfunctioning gastrointestinal tract.
A nurse is providing teaching to a patient who is receiving intermittent nasogastric feedings. Which of the following should the nurse instruct the patient to report immediately? A. A feeling of fullness B. Persistent coughing C. Discomfort in the naris D. Postfeeding belching
A. INCORRECT. This is a normal finding after intermittent feedings. It is not likely to be a cause for concern unless the feeling persists or triggers vomiting or if gastric residuals exceed 100 mL. B. CORRECT. This could indicate that the distal end of the nasogastric tube has moved into the respiratory tract. Immediate assessment is needed, because the patient might be at risk for aspiration. C. INCORRECT. Friction from the presence of the tube can be uncomfortable and indicates a need for ongoing assessment; however, this does not need to be reported immediately. D. INCORRECT. This may be a normal finding depending on the composition of the formula and the patient's usual response to the nutrients.
