Chapter 36: Gastrointestinal Intubation and Special Nutritional Modalities
10. The nurse is caring for a patient upon his return to the unit after a gastrostomy. Which of the following is a potential postoperative complication of a gastrostomy? A) Premature removal of the tube B) Dehydration C) Diarrhea D) Decrease in sodium
Ans: A Feedback: A postoperative complication of a gastrostomy is GI bleeding. Other complications include wound infection and premature removal of the tube. Dehydration, diarrhea, and a decrease in sodium levels are not typical complications.
21. The physician has written an order to discontinue the administration of parenteral nutrition. To prevent the occurrence of rebound hypoglycemia the nurse will administer: A) An isotonic dextrose solution for 1 to 2 hours after discontinuing the PN B) A hypertonic dextrose solution for 1 to 2 hours after discontinuing the PN C) 3 ampules of dextrose 50% immediately prior to discontinuing the PN D) 3 ampules of dextrose 50% one hour after discontinuing the PN
Ans: A Feedback: After administration of the PN solution is gradually discontinued, an isotonic dextrose solution is administered for 1 to 2 hours to protect against rebound hypoglycemia.
16. The nurse is preparing to administer an intravenous fat emulsion simultaneously with parenteral nutrition (PN). What approach to administration of a fat emulsion is appropriate? A) Intravenous fat emulsions may be infused simultaneously with PN through a Y-connector close to the infusion site and should not be filtered. B) The nurse should prepare for placement of another intravenous line, as intravenous fat emulsions may not be infused simultaneously through the line used for PN. C) Intravenous fat emulsions may be infused simultaneously with PN through a Y-connector close to the infusion site after running the emulsion through a filter. D) The intravenous fat emulsions can be piggy-backed into any existing IV solution that is infusing.
Ans: A Feedback: Intravenous fat emulsions may be infused simultaneously with PN through a Y-connector close to the infusion site and should not be filtered
3. Which of the following should be included in the nursing management of a nasogastric tube? A) Confirm the placement of the nasogastric tube prior to medication administration. B) Have the patient sip cool water to stimulate saliva production. C) Keep the patient in a low-Fowler's position. D) Connect the tube to continuous wall suction.
Ans: A Feedback: Nursing management of the nasogastric tube includes checking placement of the tube when using it for administration of medication. If the NG tube is used for decompression, it is attached to intermittent low suction. Patients with a nasogastric tube should be maintained on an NPO status. During the placement of a nasogastric tube, the patient should be positioned in a Fowler's position.
14. The nurse is administering total parenteral nutrition (TPN) to a patient who underwent surgery for gastric cancer. What is a major complication of TPN? A) Hyperglycemia B) Extreme hunger C) Hypotension D) Hypoglycemia
Ans: A Feedback: The solution, used as a base for most TPN, consists of a high dextrose concentration and may raise blood glucose levels significantly, resulting in hyperglycemia. Fluid overload may cause hypertension, not hypotension. Extreme hunger occurs with hypoglycemia.
1. How should the nurse determine the correct length of a nasogastric tube for placement into the stomach? A) Place the distal tip to the nose, then the ear tip and the end of the xyphoid process. B) Instruct the patient to lie prone and measure tip of nose to umbilical area. C) Insert the tube into nose until the tube fills with secretions. D) Obtain an order from the physician for the number of inches to insert the tube.
Ans: A Feedback: To insert the nasal gastric tube, the patient should be in a neutral position. The tube is measured by placing the distal tip to the nose, to the ear tip, and the end of the xyphoid process, adding 6 inches.
19. The IV team nurse is placing a peripheral intravenous line for administration of peripheral parenteral nutrition (PPN). The nurse reviews the orders and prepares to administer the PPN. Upon checking the solution against the orders, the nurse is aware that it is safest to administer a dextrose concentration no greater than 10% because dextrose concentrations greater than 10%: A) Cause a chemical phlebitis B) Are poorly absorbed by the body C) Are incompatible with lipid solutions D) Limit the length of therapy to 2 weeks
Ans: A Feedback: When administering PPN, dextrose concentrations of more than 10% should not be administered through peripheral veins because they irritate the intima of small veins, causing chemical phlebitis. Lipids are administered simultaneously to better the PPN and to protect the peripheral vein from irritation. The usual length of therapy using PPN is 5 to 7 days.
20. While recovering from bowel surgery, it is determined that the patient will require parenteral nutrition (PN) for 3 to 4 weeks. The nurse anticipates the placement of which type of catheter for PN administration? A) Peripheral catheter B) Nontunneled central catheter C) Peripherally inserted central catheter D) Tunneled central catheter
Ans: B Feedback: Nontunneled central catheters are used for short-term (less than 6 weeks) IV therapy. A peripheral catheter can be used for the administration of peripheral parenteral nutrition for 5 to 7 days. Peripherally inserted central catheters are used for intermediate-term (3 to 12 months) IV therapy. Tunneled central catheters are for long-term use and may remain in place for many years.
18. The nurse is initiating parenteral nutrition on a postoperative patient. The nurse will initiate the therapy by: A) Starting a rapid infusion rate to meet the patient's nutritional needs B) Initiating the infusion slowly and monitoring the patient's fluid and glucose tolerance C) Changing the rate of administration hourly based upon serum electrolyte values D) Increasing the rate of infusion at meal times to mimic the circadian rhythm of the body
Ans: B Feedback: PN solutions are initiated slowly and advanced gradually each day to the desired rate as the patient's fluid and glucose tolerance permits. The formulation of the PN solutions is calculated carefully each day to meet the complete nutritional needs of the individual patient based upon clinical findings and laboratory data.
13. The nurse is caring for a patient with an endotracheal (ET) tube who receives enteral feedings through a feeding tube. Before each tube feeding, the nurse checks for tube placement in the stomach as well as residual volume. The purpose of the nurse's actions is to avoid: A) Gastric ulcers B) Aspiration C) Abdominal distention D) Diarrhea
Ans: B Feedback: Protecting the patient from aspirating is essential because aspiration can cause pneumonia, a potentially life-threatening disorder. Gastric ulcers aren't a common complication of tube feeding in patients with ET or tracheostomy tubes. Abdominal distention and diarrhea can both be associated with tube feeding, but neither is immediately life-threatening.
22. A patient with a subclavian catheter is receiving parenteral nutrition (PN). In preparing a care plan for this patient, the nurse will give highest priority to which of the following nursing diagnoses? A) Risk for activity intolerance related to the presence of a subclavian catheter B) Risk for infection related to the presence of a subclavian catheter C) Risk for loneliness related to need for isolation related to the presence of a subclavian catheter D) Risk for caregiver role strain related to the care of a subclavian catheter
Ans: B Feedback: The high-glucose content of PN solutions makes the solutions an idea culture media for bacterial and fungal growth, and the central venous access devices provide a port of entry. Ambulation and activities are encouraged when the patient is physically capable. A subclavian catheter does not limit a patient's activity, nor does it require the patient to be in isolation. Care of a subclavian catheter may be performed by the patient or a family member after the completion of a training program. Training and support will be provided by a community agency or hospital-based program or the patient may receive PN infusions through an ambulatory center.
2. How can the nurse prevent reflux gastric contents through the blue vent of a gastric sump tube? A) Prime the tubing with 20 mL of normal saline. B) Keep the vent lumen above the patient's waist. C) Maintain the patient in a high-Fowler's position. D) Have the patient pin the tube to the thigh.
Ans: B Feedback: To prevent reflux of gastric contents through the vent lumen, the vent lumen is kept above the patient's waist.
9. The nurse suspects the patient is experiencing dumping syndrome. How might the nurse help to alleviate this problem? A) Stop the tube feed. B) Increase the hourly feed rate. C) Dilute the feeding solution. D) Administer an antidiarrheal.
Ans: C Feedback: Dumping syndrome can generally be alleviated by starting with a dilute solution and then increasing the concentration of the solution over several days.
17. The nurse is aware that a total nutritional admixture (TNA) is different from parenteral nutrition (PN) in that: A) There is an increased risk for catheter infections in patients who received TNA compared to patients who received PN. B) TNA can be administered over 8 hours. and PN requires around-the-clock administration C) There is an increased convenience for the nursing staff and patients when the patient receives TNA instead of PN. D) TNA does not require the use of a micron filter.
Ans: C Feedback: Intravenous fat emulsions can be admixed with components of PN to create a "three-in-one formulation" commonly called a total nutrient admixture (TNA). The TNA are mixed in one container and administered to the patient over a 24-hour period; a 1.5-micron filter is used with the TNA solution. Advantages of the TNA over PN are cost savings in preparation and equipment, decreased risk of catheter or nutrient contamination, decreased pharmacy preparation time, less nursing time, and increased patient convenience and satisfaction.
5. The nurse is caring for a patient who has had a nasogastric tube in place for 24 hours. The pH of the aspirate is 8.0, which most likely indicates: A) Gastric aspirate B) Intestinal aspirate C) Pleural aspirate D) Tracheoesophageal aspirate
Ans: C Feedback: Normal gastric aspirate has a pH of 0 to 4. Intestinal aspirate is 6 or greater, and respiratory aspirate is 7 or greater.
12. An elderly patient with Alzheimer's disease begins supplemental tube feedings through a gastrostomy tube to provide adequate calorie intake. The nurse should be concerned most with the potential for: A) Hypoglycemia B) Fluid volume excess C) Aspiration D) Constipation
Ans: C Feedback: Of the choices listed, aspiration is the most serious potential complication of tube feedings. Dehydration, not fluid volume excess, is a concern because of decreased free water intake. Hyperglycemia, not hypoglycemia, is a complication secondary to carbohydrate load of enteral feeding solutions. Constipation is a problem, but it usually isn't a serious one. The patient would most likely experience diarrhea.
15. The nurse is caring for a critically ill patient with pancreatitis. What are the indications for starting parenteral nutrition (PN) for this patient? A) 5% deficit in body weight compared to preillness weight and inability to consume oral food and fluids B) 7% deficit in body weight compared to preillness weight and restrictions to a clear liquid diet C) 10% deficit in body weight compared to preillness weight and inability to consume oral food and fluids D) 12% deficit in body weight and restrictions to a mechanical soft diet
Ans: C Feedback: The indications for PN include a 10% deficit in body weight compared to preillness weight, an inability to take oral food or fluids, and hypercatabolic situations. Pancreatitis precludes the ability to enterally or orally feed this patient.
6. When the nurse is inserting a nasogastric tube, in what position should the patient be placed? A) Recovery position B) Low-Fowler's C) High-Fowler's D) Dorsal recumbent
Ans: C Feedback: The patient should be placed in high-Fowler's position while having a nasogastric tube inserted.
4. The nurse is caring for a patient who has had a nasogastric tube in place for 2 days. The tube is draining green aspirate. What does this color of aspirate indicate? A) The tube is in the pleural space. B) The tube is in the intestine. C) The tube is in the stomach. D) The tube is in the esophagus.
Ans: C Feedback: The patient's aspirate is from the gastric area when the nurse observes that the color of the aspirate is green. Clear, yellow, and bile-colored are associated with intestinal aspirate. Tan mucus is associated with tracheobronchial secretions, and pleural secretions are pale yellow.
11. The home care nurse is assessing management of the patient's gastrostomy. Which of the following statements indicates that the patient is managing the tube correctly? A) " I clean my stoma twice a day with alcohol." B) " I am placing sterile dressings on my stoma site." C) "I am flushing my tube with 30 mL of water after my feeds." D) "I have been giving my medications all at the same time to avoid hassle."
Ans: C Feedback: The tube should be flushed after each feed with 15 to 30 mL of water. Routine site care should include cleansing the site daily with soap and water. Clean dressing changes are acceptable. Medications should be given separately, flushing in between.
7. While caring for a patient with a nasogastric tube, how might the nurse best check correct placement of the tube? A) Auscultation after injecting air through the tube B) Assessment of color of aspirate and laboratory testing of the aspirate C) By taping the tube in place after the initial x-ray that confirms placement D) A combination of visual assessment of aspirate, pH measurement, and measurement of tube length
Ans: D Feedback: A combination of three methods is recommended instead of the auscultation. The three methods include: measurement of tube length, visual assessment of aspirate, and pH measurement.
8. A patient who is having difficulty clearing the airway, has a respiratory rate of 28 and a temperature of 38.9° C. The patient has a nasogastric tube. What might this assessment indicate? A) Angina B) Hyperglycemia C) Fistula D) Aspiration pneumonia
Ans: D Feedback: Pulmonary complications from nasogastric tube placement can occur from aspiration or impairment of clearing the airway. Signs and symptoms include difficulty clearing the airway, tachypnea, and fever.
