Fund EXAM 2 - nutrition & NGT (p)

Which of the following are expected normal characteristics of gastric contents? Select all that apply. 1. greenish color 2. reddish color 3. "coffee ground" appearance 4. pH 1-4 5. clear

1, 4, 5.

which of the following are appropriate expected outcomes when planning for a patient with enteral tube feedings? Select all that apply. 1. patient verbalizes no abdominal discomfort 2. patient weight increases 3. laboratory values are within acceptable limits by discharge 4. NAP will verify tube placement before feedings 5. tube feedings will be administered at room temperature 6. patient does not show signs of respiratory distress

1, 2, 3, 6

HCP orders state to advance intermittent tube feedings to 240ml every 4 hours "as tolerated". which of the following demonstrates toleration of feedings? 1. gastric residual of 30ml 2. absence of diarrhea 3. absence of constipation 4. absence of nausea 5. increased abdominal girth 6. gastric residual of 250 ml

1, 2, 4.

Jordan Chilton is hospitalized with sepsis (a systemic inflammatory response to infection). She has an NG feeding tube to assist in meeting her nutritional requirements. The continuous feeding is presently infusing. She is receiving the medications listed below: 20 mg Pepsid at bedtime, 500 mg levaquin by mouth daily, 325 mg ferrous sulfate by mouth daily, 325 aspirin by mouth daily. What are some factors that could place Jordan at risk for tube dislodgement? 1. harsh coughing 2. retching/vomiting 3. aspirating gastric contents 4. continuous tube feedings 5. frequent nasotracheal suctioning

1, 2, 5.

Which patient (s) would benefit from enteral nutrition? Select all that apply. 1. MS patient 2. stroke pt with dysphagia 3. paralytic ileus 4. malabsorption syndrome patient 5. head/neck cancer patient 6. pt with massive small bowel resection

1, 2, 5.

After placing an NG tube into a patient, you would expect the following outcomes. Select all that apply. 1. tube is placed into stomach 2. nasal mucosa remains pink and without irritation 3. tube is placed into the intestine 4. patient coughs extensively after placement

1, 2.

which of the following could increase pt risk of gastric bleeding that results in positive occult blood test of gastric contents? Select all that apply. 1. anticoagulants 2. antibiotics 3. aspirin 4. steroids 5. antiinflammatory agents 6. tylenol

1, 3, 4, 5

Which of the following items, if consumed recently, could provide false results when performing testing of gastric contents? Select all that apply. 1. spinach 2. cantelope 3. red meat 4. iron supplements 5. avocados 6. antacids

1, 3, 4, 6

What action requires correction when inserting NG tube? select all that apply. 1. you tape the tube in place after x-ray confirmation of placement 2. you have the patient bend his head forward during placement 3. you measure from the tip of the nose, to the earlobe, to the xiphoid process 4. you leave the guidewire in place at all times 5. you wear nonsterile gloves to perform the procedure 6. to increase patient comfort, you place the tube in ice before insertion

1, 4, 6.

Which of the following are appropriate measures for evaluating gastrooccult tests? Select all that apply. 1. color changes on gastrooccult test 2. amount of emesis 3. time pt. last consumed fluids 4. previous gastrooccult results 5. emesis pH 6. pt activity level 7. color and characteristics of emesis.

1,2,3,4,5,7

expected outcome of NG insertion

1. Tube is verified as placed in stomach or intestine. 2. Feeding tube will remain patent. 3. Patient has no respiratory distress (e.g., increased respiratory rate, coughing, poor color) or show signs of discomfort and/or nasal trauma.

what is the maximum time that formula can be left in an open system continuous enteral feeding?

12 hours

Maximum hang time for formula

12 hours in an open system, 24 to 48 hours in a closed, ready-to-hang system (if it remains closed)

when a bolus tube feedings is being administered, what is the minimum height that the syringe should be raised over the insertion site?

18 inches

After inserting NG tube, which of the following actions should be included in evaluation of the procedure? Select all that apply. 1. determine pt temperature and WBC count 2. auscultation of lung sounds 3. obtaining of x-ray results 4. observing pt for continual signs of gagging/coughing 5. inspection of nasal mucosa

2, 3, 4, 5

You have received an order to place an NG feeding tube and to being feedings after placement. Which of the following may contradict placement? Select all that apply. 1. patient is on oxygen therapy 2. patient is on anticoagulant therapy with recent nosebleed 3. patent right naris ; slight edema of mucosa left naris 4. patient gag reflex is present 5. absence of bowel sounds in the four quadrants

2, 5

what is the maximum time that formula can be left in a closed, ready to hang system of continuous enteral feeding?

24-48 hours

after administering medications via tube, when should you return for evaluation of patient response?

30 minutes

if pt is tolerating feedings, rate of continuous feedings may be increased

30-60 ml every 8-12 hours until target rate is achieved.

if pt is tolerating feedings, rate of intermittent feedings may be increased

50 ml per feeding, per day

reliable indicator of stomach placement

A pH reading of 5.0 or less

signs of malnutrition

Albumin 3.0 ; lymphocytes 1700 mm3

conditions that increase risk for spontaneous tube dislocation

Altered level of consciousness, agitation, retching, vomiting, coughing, Nasotracheal suction

After NG placement, what must be done before feedings can begin?

X-ray to verify correct placement

You are reviewing the patient's medication record. Which of the medications may alter the pH test results? a. Pepcid (famotidine) b. Levaquin (levofloxacin) c. Feosol (ferrous sulfate)

a. H2 receptor antagonists reduce the volume of gastric acid secretion and the acid concentration of secretions.

You notice that the infusion pump was accidentally turned off for a few hours. Knowing this, what consideration should be made? a. You should make sure that the tube feeding does not hang for more than 12 hours. b. You should assess the patient for dehydration. c. You should inform the patient to avoid touching the equipment in the future. d. You should make a notation by the patient's daily weight.

a. Maximum hang time for formula is 12 hours in an open system to prevent spoiling and contamination of the system and subsequent infection in the client.

You aspirate gastric contents to check the residual volume. Fifty milliliters are obtained. You return the gastric contents to the patient's stomach. The patient asks you why you did this. Your best response is: a. "Returning the aspirate prevents fluid and electrolyte imbalance." b. "To clear the tubing in preparation for starting the feeding" c. "To prevent air from entering the stomach" d. "The risk of abdominal discomfort is lessened if the aspirate is returned to the stomach."

a. Return of aspirate prevents fluid and electrolyte imbalance.

You are planning to verify NG feeding tube placement by pH testing. Which result would indicate that the feeding tube is in the expected location? a. pH of 7 b. pH of 3 c. pH of 6

b. Gastric contents would be expected to test at a pH of 1 to 5.

What should you do if the patient's residual volume is more than 300 mL? a. Assist pt to ambulate. b. Hold the feeding for 1 hour and recheck residual. c. Slow the infusion rate. d. Change the type of formula being used.

b. If the residual amount is greater than the last hour's infusion or greater than 250 mL, you should hold the feeding for 1 hour and recheck residual or refer to facility policy.

You are flushing a patient's feeding tube with a bolus of water (administered by gravity) when he complains of abdominal cramping. What can you do to slow the rate of infusion? a. Elevate the syringe. b. Lower the syringe. c. Raise the head of the patient's bed to 30 degrees. d. Refill the syringe.

b. Lowering the syringe will decrease the rate of flow. The syringe should be less than 18 inches above the insertion site to allow it to empty gradually over several minutes, which reduces the risk of abdominal discomfort.

Jordan Chilton is hospitalized with sepsis (a systemic inflammatory response to infection). She has an NG feeding tube inserted to assist in meeting her nutritional requirements. She has a continuous tube feeding (open system) presently infusing at 30 mL/hr. How frequently should Jordan's feeding tube bag and tubing be changed? a. Every 8 hours b. Every 24 hours c. Every 72 hours d. Whenever the feeding is completed

b. Maximum hang time for a closed system is 24-48 hours; in an open system the feeding tube bag with tubing should be changed every 24 hours.

If Jordan's gastric feeding tube has migrated to the lung, what would be the expected pH test result? a. 5 b. 6 c. 4 d. 0

b. Pleural fluid is at a pH of 6 or greater.

The radiologist calls stating that the end of Jordan's feeding tube is in the esophagus and the tube should be advanced approximately 7.5 cm to reach the stomach. You return to the patient's room and find that the stylet has already been removed. What action should you take next? a. Remove the tape, reinsert the stylet, and advance the tube the desired amount. b. Remove the tape, advance the tube the desired amount, and have another x-ray taken. c. Remove the tape and feeding tube & start over. d. Contact the health care provider to obtain an order for an alternate route of nutritional support. e. Use the feeding tube as it is placed, since the formula will reach the stomach anyway.

b. The next nursing action is to attempt to advance the tube the desired amount and then follow with a repeat x-ray. The stylet should never be reinserted because accidental perforation could seriously injure the patient.

A patient has a medical history of cerebrovascular accident with impaired swallowing, stomach cancer with gastric resection, anemia, and hypertension. What route of feeding would you expect the patient to have? a. Oral b. NG c. NI d. Parenteral

c. Because a gastric resection contraindicates NG feeding, the expected route would be NI.

A patient has been receiving ranitidine hydrochloride (Zantac), an H2 receptor antagonist, for treatment of a duodenal ulcer. How may this affect pH testing? a. It does not affect pH testing. b. It will decrease the gastric pH reading. c. It will increase the gastric pH reading.

c. H2 receptor antagonists, such as Zantac, reduce the volume of gastric acid secretion and the acid concentration of secretions, thus increasing gastric pH.

You are inserting an NG tube when the patient begins to choke and turn blue. What is your next best action? a. Have the patient tilt his head to his chest and insert the tube quickly. b. Ask the patient to take a sip of water and swallow to facilitate passage of the tube. c. Stop advancing the tube and pull back, then try to advance the tube once more. d. Remove the tube, administer oxygen, and start over.

c. If resistance is met or the patient starts to cough, choke, or become cyanotic, stop advancing the tube and pull the tube back.

The NAP reports to you that Jordan seems to be having difficulty breathing and appears "a little blue". The feeding tube remains secured with tape, and the infusion pump is not alarming. What action should you take at this time? a. Tell the NAP to turn the feeding tube down to a slower rate. b. Nothing, since the tube remains taped and the infusion pump is operating without alarming. c. Go and assess the patient, turn the feeding off, and notify the health care provider. d. Ask the NAP if Jordan has been coughing or retching.

c. You should assess the patient, and if the patient is displaying respiratory symptoms, turn the feeding off and notify the health care provider. You should be prepared to initiate oxygen therapy and obtain a chest x-ray.

signs and symptoms of inadvertent respiratory compromise during feeding

coughing, choking, lowered O2 sats

A nursing student asks the staff nurse why auscultation is not used for verifying feeding tube placement. The nurse's best response is: a. "It creates gaseous distention and discomfort in the patient when performed repeatedly." b. "The air entering the enteral tube can introduce bacteria also." c. "Additional oxygen can alter the patient's acid-base balance, thus altering pH test results." d. "A tube placed in the lungs/pharynx/esophagus sounds like air entering the stomach."

d. The sound created when air is inserted through the feeding tube can be mistaken for correct tube placement, when in reality the tube may be inadvertently placed in the lungs, pharynx, or esophagus.

Jordan Chilton is hospitalized with sepsis. She is to have an NG feeding tube inserted to assist in meeting her nutritional requirements. As you are inserting the feeding tube, resistance is felt and Jordan begins to cough. What action should you take? a. Withdraw the tube completely and insert in the other naris. b. Push the tube in harder until past the area of resistance. c. Instill 30 mL of water in the tube to aid insertion. d. Continue with insertion as this is to be expected; encourage Jordan to swallow. e. Stop advancing the tube and pull the tube back.

e. If resistance is met or the patient starts to cough, choke, or become cyanotic, stop advancing the tube and pull the tube back.

What should you do first when preparing to administer medications through a feeding tube? a. Add the medication to the tube-feeding bag. b. Stop the tube feeding 30 minutes before and after administering the medication. c. Ask the physician for an alternate route for medication administration. d. Change the patient to intermittent feedings. e. Assess for potential drug-food interactions.

e. It is best to give medications and tube feedings at separate intervals; however, if drugs must be administered with a feeding, you should assess for potential drug-food interactions.

Jordan Chilton is hospitalized with sepsis (a systemic inflammatory response to infection). She has an NG feeding tube inserted to assist in meeting her nutritional requirements. She has a continuous tube feeding (open system) presently infusing at 30 mL/hr. Because she has a continuous tube feeding, when should gastric residual volume be checked? a. It is unnecessary to check gastric residual with an ongoing infusion. b. Every other day c. Every 2 to 3 hours d. Whenever she complains of feeling bloated e. Every 4 to 6 hours

e. Patients who receive continuous drip feedings should have residuals checked every 4 to 6 hours.

feeding tube positioning should be checked how often?

every 4 to 6 hours and before administering medications or feedings

after NG placement, how often should mucosa be assessed?

every 8 hours

Which of the following may be crushed or, if a capsule, opened and dissolved in water? a. Slow-K (potassium chloride) 10 mEq PO daily b. Nitrostat (nitroglycerin) 0.4 mg sublingual every 5 minutes, no more than times 3, per request of chest pain c. E-Mycin (erythromycin) 333 mg tablet PO every 8 hours d. Enteric-coated aspirin (acetylsalicylic acid) 325 mg PO every day e. Wellbutrin slow release (bupropion) 150 mg PO daily f. Keflex (cephalexin) 250 mg PO every 6 hours

f. Because it is not a sustained-release capsule, the cephalexin capsule may be opened and the powder dissolved in water for administration through a feeding tube.

true/false: When a patient vomits dark emesis, the emesis is most likely analyzed with a Gastroccult test to determine what the patient ate that upset his stomach.

false The emesis is tested for occult blood.

true/false: A health care provider's order is necessary to verify tube placement by pH testing.

false. Although a health care provider's order is required for insertion and radiological verification of placement, it is unnecessary for routine verification of tube placement by pH testing. Testing the pH of aspirate is an expectation of competent nursing care of the patient with an enteral tube.

true/false: The six rights of medication administration do not apply when administering medications per feeding tube.

false. Any time any type of medication is administered, the six rights of medication administration should be applied.

true/false: To determine the patient's tolerance of feedings, you should check the patient's urine output every 6 hours until maximum administration rate is achieved for 24 hours.

false. Finger-stick blood glucose levels assist in determining tolerance to feedings and should be monitored every 6 hours until maximum administration rate is reached and maintained for 24 hours. Intake and output should be monitored every 8 hours.

true/false: If residual volume is greater than 250 mL, return 250 mL to the patient, discard the excess residual, and administer the medication, noting this on the patient's record.

false. If residual volume remains greater than 250 mL, hold medication and contact health care provider for further orders or follow facility protocol.

true/false: You may delegate analysis of gastric contents to NAP, including insertion of a nasogastric tube, if necessary.

false. Inserting a nasogastric tube is an invasive procedure and should be performed by you.

true/false: Avoid administering medications and tube feedings at the same time because this may overfill the stomach, resulting in abdominal discomfort and excessive residual volume.

false. Nurses should avoid administering medications and tube feedings at the same time; however, the rationale is incorrect: give at separate intervals to avoid potential drug-food interactions.

true/false: Because Mr. Jackson has wall suction, you may test gastric secretions from the suction canister.

false. Secretions should be aspirated from Mr. Jackson's nasogastric tube for testing.

true/false: As long as the patient does not demonstrate respiratory symptoms (choking, coughing, cyanosis), pH testing of aspirate is unnecessary.

false. The absence of signs and symptoms of respiratory difficulty does not ensure nonrespiratory placement, especially in patients with decreased level of consciousness or altered cough and gag reflex.

true/false: The normal gastric pH is 4.6 to 8.

false. The normal gastric pH is 1 to 4. Intestinal contents are less acidic—above 4.0. Respiratory secretions are more alkaline—above 5.5. The normal pH of urine is 4.6 to 8.

true/false: The nurse has received an order to insert a nasogastric feeding tube. The nurse should start with the selection of a 12 French nasogastric feeding tube to enhance patient comfort.

false. The nurse should select the smallest diameter possible to enhance patient comfort. An 8 French tube has a smaller diameter than a 12 French tube.

true/false: When initiating enteral tube feedings, you should weigh the patient weekly.

false. The patient should be weighed daily until maximum administration rate is reached and maintained for 24 hours; then the patient should be weighed three times per week.

true/false: The nasogastric tube should remain attached to intermittent suction during gastric pH testing.

false. You must temporarily disconnect the nasogastric tube from the suction source in order to obtain a gastric sample.

Principles of giving medications safely through a feeding tube include

flushing tube to prevent clogging Never mixing medications with formula Never mixing medications together

gastric content analysis can aid HCP to screen and treat

hematemesis & alterations in stomach acidity

Preferably, medications administered by enteral tubes

should be in liquid form

medications that cannot be crushed

sublingual, sustained-release, chewable, long-acting, or enteric-coated medications

true/false: If allowed by facility policy, NAP may perform Gastroccult testing on emesis.

true.

true/false: When a patient has a nasogastric tube in place, gastric pH may be tested to verify placement of the tube in the stomach.

true.

true/false: Sterile gloves are not required for inserting a nasoenteric feeding tube.

true. Clean gloves are used for inserting a nasoenteric or nasogastric feeding tube.

true/false: Evaluation of tube feedings should include monitoring and recording residual volumes, monitoring the patient's respiratory status, and asking the patient if abdominal cramping or nausea is experienced during or following feedings.

true. Evaluation includes measures to verify tolerance of tube feedings and absence of complications. Residual volume should be monitored and recorded on an ongoing basis.

true/false: You should elevate the head of the bed when administering medication through a feeding tube.

true. Keeping the head above the stomach reduces risk of aspiration.

true/false: If a patient has an NG tube connected to suction, you may want to seek an alternate route or if allowed, turn the suction source off for 1 hour after medications are administered.

true. Patients with GI suction are unable to benefit from oral medication because the medications are removed before being absorbed. Contact the physician for an order to administer medications by an alternate route.

true/false: The last medication administered via feeding tube should be followed with 30 to 60 mL of water.

true. The feeding tube should be flushed with 30 to 60 mL of water to avoid clogging of the tube with medication and to ensure the medication enters the stomach, where it can be absorbed.

true/false: After administering medications through a feeding tube, appropriate documentation includes recording on the medication administration record and intake and output record.

true. The nurse should document on both the patient's medication administration record and intake and output record.

true/false: Two methods you may use to prevent clogging of the feeding tube are to crush medications well before dissolving them in water and to flush the tube with water to clear the tube after medication administration.

true. These actions will aid in meeting the expected outcome of avoidance of tube clogging from medication administration.

gastric contents

usually green or clear with a pH of 1-4